Individual
DR. TAMARA DUNN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
16 FELTON PL # B, CARTERSVILLE, GA 30120-2152
(770) 382-3536
(770) 382-1915
Mailing address
16 FELTON PL # B, CARTERSVILLE, GA 30120-2152
(770) 382-3536
(770) 382-1915
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN011041
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00945128A
—
GA
01
—
100299
AVESIS MEDICAID
GA
01
—
9181142
DORAL MEDICAID
GA
Enumeration date
12/04/2006
Last updated
07/08/2007
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