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General NPI Number Information
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NPI Number | 1366688350
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Entity Type | Organization
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Legal Business Name | RUSSELL M. GORMAN, DDS., PA
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Dates
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Enumeration Date | 12/23/2008
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Last Update Date | 12/23/2008
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Provider Practice Location Address
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Address Line | 308 WEST ST LOUIS STREET
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City | HOT SPRINGS
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State | AR
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Zip | 71913
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Country | US
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Telephone | 501-321-1977
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Fax | 501-321-1750
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Provider Business Mailing Address
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Address Line | 308 WEST ST LOUIS STREET
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City | HOT SPRINGS
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State | AR
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Zip | 71913
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Country | US
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Telephone | 501-321-1977
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Fax | 501-321-1750
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | RUSSELL M GORMAN
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Credential | D.D.S.
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Telephone | 501-321-1977
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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 | AR3238
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License Number State | AR
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