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General NPI Number Information
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NPI Number | 1346704889
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Entity Type | Individual
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Provider Name | JAMIE ELLEN RUSSELL RDH
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Gender | Female
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Dates
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Enumeration Date | 01/29/2019
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Last Update Date | 01/29/2019
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Provider Practice Location Address
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Address Line | 26 QUEEN ST STE 13
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City | WORCESTER
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State | MA
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Zip | 01610-2478
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Country | US
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Telephone | 508-963-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 13 A VINTON RD
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City | CHARLTON
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State | MA
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Zip | 01507-6544
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Country | US
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Telephone | 508-688-9890
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Fax |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 13270
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License Number State | MA
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