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General NPI Number Information
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NPI Number | 1902248149
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Entity Type | Organization
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Legal Business Name | RUSSEL HAMARNAH DMD PLLC
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Dates
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Enumeration Date | 07/29/2013
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Last Update Date | 07/29/2013
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Provider Practice Location Address
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Address Line | 1020 5TH ST SE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-4210
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Country | US
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Telephone | 863-299-1579
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Fax | 863-299-7086
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Provider Business Mailing Address
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Address Line | 1020 5TH ST SE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-4210
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Country | US
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Telephone | 863-299-1579
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Fax | 863-299-7086
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Authorized Official
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Title or Position | OWNER
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Name | RASSEL ELHAMARNAH
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Credential | DMD
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Telephone | 863-299-1579
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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