MEDICARE: DR. JAMES TIMOTHY RUSSIN DDS

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	1223E0200X	Endodontics	DN 10828	FL

General Provider Information

NPI Number	:	1609879311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES TIMOTHY RUSSIN DDS

Provider Business Mailing Address
First Line	:	123 N OAKWOOD AVE
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33510-4629
Country	:	US
Telephone Number	:	813-684-6509
Fax Number	:	813-685-9447

Provider Business Practice Location Address
First Line	:	123 N OAKWOOD AVE
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33510-4629
Country	:	US
Telephone Number	:	813-684-6509
Fax Number	:	813-685-9447

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	11/05/2010

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