Mr John Douglas Russell, DDS is a
Dentist based in Shasta Lake City, California. Mr John Douglas Russell is licensed to practice in California (license number 20042) and his current practice location is
4178 Ashby Court, Shasta Lake City, California. He can be reached at his office (for appointments etc.) via phone at
(530) 275-2910.
NPI number for Mr John Douglas Russell is 1902958077 and his current mailing address is 4178 Ashby Court, Shasta Lake City, California. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1902958077.
Healthcare Provider's Profile
| Full Name | Mr John Douglas Russell |
|---|
| Gender | Male |
|---|
| Speciality | Dentist |
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| Location | 4178 Ashby Court, Shasta Lake City, California |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1902958077
- Provider Enumeration Date: 01/17/2007
- Last Update Date: 07/08/2007
Medical Identifiers
Medical identifiers for Mr John Douglas Russell such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1902958077 | NPI | - | NPPES |
| B2004201 | Medicaid | CA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 122300000X | Dentist | 20042 (California) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr John Douglas Russell is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr John Douglas Russell, DDS
4178 Ashby Court,
Shasta Lake City, CA 96019
Ph: (530) 275-2910 | Mr John Douglas Russell, DDS
4178 Ashby Court,
Shasta Lake City, CA 96019
Ph: (530) 275-2910 |
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