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930 Park Ave Bremerton WA 98337-1551 | |
| (360) 377-7621 | |
| (360) 377-6265 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 930 Park Ave, Bremerton, Washington |
| Authorized Official Name and Position | Nathan Gregory Russell (DOCTOR/OWNER) |
| Authorized Official Contact | 3603777621 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
930 Park Ave Bremerton WA 98337-1551 Ph: (360) 377-7621 | 930 Park Ave Bremerton WA 98337-1551 Ph: (360) 377-7621 |
| NPI Number | 1104249465 |
|---|---|
| Provider Enumeration Date | 01/22/2014 |
| Last Update Date | 01/22/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104249465 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DE00009670 (Washington) | Primary |
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