Individual
DR. HEATHER M RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
1090 W PARK PL, COEUR D ALENE, ID 83814-2785
(208) 292-0697
(208) 292-0357
Mailing address
PO BOX 1387, HAYDEN, ID 83835-1387
(208) 415-0299
(208) 625-2070
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
60980
CA
122300000X
Dentist
Primary
D-5195
ID
Other
Enumeration date
09/24/2012
Last updated
08/25/2021
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