Organization
JOHN RUSSELL, III, D.M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN RUSSELL III D.M.D. (PRESIDENT)
(662) 328-1521
Entity
Organization
Contact information
Practice address
499 GLOSTER CREEK VLG, TUPELO, MS 38801-4600
(662) 678-1028
Mailing address
206 N BROOKMOORE DR, COLUMBUS, MS 39705-2020
(662) 328-1521
(662) 328-1237
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
OR15888
MS
Other
Enumeration date
04/13/2009
Last updated
04/13/2009
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