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NPI Code Detail

MEDICARE: DR. HARRELL SCOTT RUSSELL D.M.D.

MEDICARE: DR. HARRELL SCOTT RUSSELL D.M.D.
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
11223G0001XGeneral Practice Dentistry4955AL

General Provider Information

NPI Number : 1770586760
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HARRELL SCOTT RUSSELL D.M.D.
Provider Business Mailing Address
First Line : 58 MANNING PL
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35242-1809
Country : US
Telephone Number : 205-408-3882
Fax Number : 205-408-3884
Provider Business Practice Location Address
First Line : 58 MANNING PL
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35242-1809
Country : US
Telephone Number : 205-408-3882
Fax Number : 205-408-3884
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 07/08/2007

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