| John Russell, Iii, D.m.d., Pa | |
|
206 Brookmoore Drive Columbus MS 39705 | |
| (662) 328-1521 | |
| (662) 328-1237 |
| Full Name | John Russell, Iii, D.m.d., Pa |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 206 Brookmoore Drive, Columbus, Mississippi |
| Authorized Official Name and Position | John Russell (PRESIDENT) |
| Authorized Official Contact | 6623281521 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| John Russell, Iii, D.m.d., Pa 206 Brookmoore Drive Columbus MS 39705 Ph: (662) 328-1521 | John Russell, Iii, D.m.d., Pa 206 Brookmoore Drive Columbus MS 39705 Ph: (662) 328-1521 |
| NPI Number | 1184721367 |
|---|---|
| Provider Enumeration Date | 09/20/2006 |
| Last Update Date | 04/10/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184721367 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | OR15888 (Mississippi) | Primary |
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