MEDICARE: DTODD RUSSELL 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	1223G0001X	General Practice Dentistry	20212	OH

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

General Provider Information

NPI Number	:	1639191943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DTODD RUSSELL DDS

Provider Business Mailing Address
First Line	:	9769 VALLEY VIEW ROAD
Second Line	:
City	:	MACEDONIA
State	:	OH
Zip	:	44056-1950
Country	:	US
Telephone Number	:	330-468-6670
Fax Number	:

Provider Business Practice Location Address
First Line	:	9769 VALLEY VIEW ROAD
Second Line	:
City	:	MACEDONIA
State	:	OH
Zip	:	44056-1950
Country	:	US
Telephone Number	:	330-468-6670
Fax Number	:

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/09/2007

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Directions to “ DTODD RUSSELL DDS” Practice Location

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