Organization
RUSSELL DENTAL GROUP, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS DUCKWORTH RUSSELL III D.D.S. (CORPORATION PRESIDENT, DENTIST)
(731) 772-2107
Entity
Organization
Contact information
Practice address
130 PEACHTREE PLZ, BROWNSVILLE, TN 38012-2500
(731) 772-2107
Mailing address
130 PEACHTREE PLZ, BROWNSVILLE, TN 38012-2500
(731) 772-2107
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2338
TN
1223G0001X
General Practice Dentistry
6983
TN
1223G0001X
General Practice Dentistry
7764
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014423
TENNCARE
TN
Enumeration date
09/29/2005
Last updated
08/22/2020
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