Healthcare Provider Details

I. General information

NPI: 1558275131
Provider Name (Legal Business Name): RED HILLS ORAL AND FACIAL SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2648 CENTENNIAL PL
TALLAHASSEE FL
32308-0572
US

IV. Provider business mailing address

2648 CENTENNIAL PL
TALLAHASSEE FL
32308-0572
US

V. Phone/Fax

Practice location:
  • Phone: 850-523-3000
  • Fax: 850-523-0831
Mailing address:
  • Phone: 850-523-3000
  • Fax: 850-523-0831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. RUSSELL B WALTHER
Title or Position: OWNER / ORAL SURGEON
Credential: DDS, MD
Phone: 850-523-3000