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General NPI Number Information
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NPI Number | 1609879311
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Entity Type | Individual
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Provider Name | JAMES TIMOTHY RUSSIN DDS
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Gender | Male
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 11/05/2010
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Provider Practice Location Address
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Address Line | 123 N OAKWOOD AVE
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City | BRANDON
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State | FL
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Zip | 33510-4629
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Country | US
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Telephone | 813-684-6509
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Fax | 813-685-9447
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Provider Business Mailing Address
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Address Line | 123 N OAKWOOD AVE
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City | BRANDON
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State | FL
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Zip | 33510-4629
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Country | US
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Telephone | 813-684-6509
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Fax | 813-685-9447
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN 10828
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License Number State | FL
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