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General NPI Number Information
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NPI Number | 1295981850
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Entity Type | Organization
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Legal Business Name | DAVID R RUSSELL DMDPC, DBA'RISING SUN DENTAL CARE'
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 301 STATE DRIVE
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City | ELIZABETHVILLE
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State | PA
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Zip | 17023
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Country | US
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Telephone | 717-692-4847
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Fax | 717-692-4848
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Provider Business Mailing Address
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Address Line | 301 STATE DRIVE
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City | ELIZABETHVILLE
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State | PA
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Zip | 17023
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Country | US
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Telephone | 717-692-4847
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Fax | 717-692-4848
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. SARA LOUISE LYNDE
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Credential | DMD
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Telephone | 717-692-4847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS037223
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS108472
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License Number State | PA
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