Healthcare Provider Details

I. General information

NPI: 1043238157
Provider Name (Legal Business Name): RUSSELL ALAN SETTLE JR. D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 GOETZ LN
OWENSBORO KY
42301-9663
US

IV. Provider business mailing address

4921 GOETZ LN
OWENSBORO KY
42301-9663
US

V. Phone/Fax

Practice location:
  • Phone: 270-684-9244
  • Fax: 270-685-1193
Mailing address:
  • Phone: 270-684-9244
  • Fax: 270-685-1193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6637
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6637
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: