Healthcare Provider Details

I. General information

NPI: 1023017779
Provider Name (Legal Business Name): RUSSELL FRANKLIN LAMIELLE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7265 PORTAGE ST NW SUITE A
MASSILLON OH
44646-7826
US

IV. Provider business mailing address

7265 PORTAGE ST NW SUITE A
MASSILLON OH
44646-7826
US

V. Phone/Fax

Practice location:
  • Phone: 330-498-9730
  • Fax: 330-498-9753
Mailing address:
  • Phone: 330-498-9730
  • Fax: 330-498-9753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21028
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: