Individual
TRAVIS ANDRE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
280 CONCORD PKWY S STE 110A, CONCORD, NC 28027-2704
(704) 920-1070
(704) 920-1071
Mailing address
300 MOORESVILLE RD, KANNAPOLIS, NC 28081-0304
(704) 920-1070
(704) 920-1071
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
9255
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX9255
—
SC
Enumeration date
09/17/2018
Last updated
02/20/2026
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