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General NPI Number Information
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NPI Number | 1295823136
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Entity Type | Individual
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Provider Name | RUSSELL W REDDELL DDS
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1005 N 16TH ST
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City | LAMESA
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State | TX
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Zip | 79331-3151
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Country | US
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Telephone | 806-872-6310
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Fax | 806-872-6319
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Provider Business Mailing Address
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Address Line | 1000 FARM MARKET ROAD 300
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City | LEVELLAND
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State | TX
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Zip | 79336-6235
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Country | US
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Telephone | 806-897-1987
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Fax | 806-894-3378
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 19405
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License Number State | TX
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