| Russell Family Dentistry Llc | |
|
495 Woodford Street Portland ME 04103 | |
| (207) 772-6966 | |
| (207) 761-0756 |
| Full Name | Russell Family Dentistry Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 495 Woodford Street, Portland, Maine |
| Authorized Official Name and Position | Keith Edmund Russell (MEMBER/DENTIST) |
| Authorized Official Contact | 2077726966 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Russell Family Dentistry Llc 495 Woodford Street Portland ME 04103 Ph: (207) 772-6966 | Russell Family Dentistry Llc 495 Woodford Street Portland ME 04103 Ph: (207) 772-6966 |
| NPI Number | 1659449940 |
|---|---|
| Provider Enumeration Date | 12/03/2006 |
| Last Update Date | 05/12/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659449940 | NPI | - | NPPES |
| 154630000 | Other | ME | MAINE CARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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