Individual
DR. CARL M. RUSSELL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD, PHD
Contact information
Practice address
6488 HICKORY FLAT HWY, CANTON, GA 30115-7235
(770) 720-8138
(770) 720-7580
Mailing address
6488 HICKORY FLAT HWY, CANTON, GA 30115-7235
(770) 720-8138
(770) 720-7580
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
11115
GA
Other
Enumeration date
03/04/2006
Last updated
07/08/2007
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