| Gregory S Russell, Dmd, P.a. | |
|
11200 Racetrack Rd Ste 204 Berlin MD 21811-3808 | |
| (410) 208-3333 | |
| (410) 208-3330 |
| Full Name | Gregory S Russell, Dmd, P.a. |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 11200 Racetrack Rd Ste 204, Berlin, Maryland |
| Authorized Official Name and Position | Gregory S Russell (PRESIDENT) |
| Authorized Official Contact | 4102083333 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gregory S Russell, Dmd, P.a. 11200 Racetrack Rd Ste 204 Berlin MD 21811-3808 Ph: (410) 208-3333 | Gregory S Russell, Dmd, P.a. 11200 Racetrack Rd Ste 204 Berlin MD 21811-3808 Ph: (410) 208-3333 |
| NPI Number | 1619267903 |
|---|---|
| Provider Enumeration Date | 04/08/2011 |
| Last Update Date | 12/23/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619267903 | NPI | - | NPPES |
| 13423 | Other | MD | DENTAL LIC# |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | 13423 (Maryland) | Primary |
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