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NPI Code Detail

MEDICARE: MY CHAU ELIZABETH RUSSELL R.D.H.

MEDICARE: MY CHAU ELIZABETH RUSSELL R.D.H.
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
1124Q00000XDental Hygienist12680TX

General Provider Information

NPI Number : 1528184066
Entity Type Code : Individual
Provider Name (Legal Business Name) : MY CHAU ELIZABETH RUSSELL R.D.H.
Provider Business Mailing Address
First Line : 2213 HUNTERS RUN DR
Second Line :
City : PLANO
State : TX
Zip : 75025-4799
Country : US
Telephone Number : 972-762-2852
Fax Number :
Provider Business Practice Location Address
First Line : 8608 PRESTON RD
Second Line : SUITE 112
City : PLANO
State : TX
Zip : 75024-3316
Country : US
Telephone Number : 214-619-6329
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 07/08/2007

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