MEDICARE: DR ALAN RUSSELL PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	09480	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	13D69RU	OTHER	MN	BLUE CROSS BLUE SHIELD
3	710609	OTHER	MN	UNITED OF CONCORDIA

General Provider Information

NPI Number	:	1194997783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR ALAN RUSSELL PLC

Provider Business Mailing Address
First Line	:	2010 27TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1108
Country	:	US
Telephone Number	:	612-336-8478
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 27TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1108
Country	:	US
Telephone Number	:	612-336-8478
Fax Number	:

Authorized Official
Title or Position	:	DENTAL ASSISTANT
Name	:	MRS. KATHY HUBRED
Credential	:	CRDA
Telephone Number	:	612-336-8478

Provider Enumeration Date	:	03/24/2008
Last Update Date	:	06/11/2008

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Directions to “DR ALAN RUSSELL PLC ” Practice Location

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