MEDICARE: DR. NATHAN RUSSELL CALL D.D.S

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	9922	UT
2	1223P0221X	Pediatric Dentistry	5865630-9924	UT

General Provider Information

NPI Number	:	1790110732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN RUSSELL CALL D.D.S

Provider Business Mailing Address
First Line	:	1251 NORTHFIELD RD STE 201
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84721-8623
Country	:	US
Telephone Number	:	435-609-0885
Fax Number	:

Provider Business Practice Location Address
First Line	:	1251 NORTHFIELD RD STE 201
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84721-8623
Country	:	US
Telephone Number	:	435-609-0885
Fax Number	:

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

Provider Enumeration Date	:	09/10/2013
Last Update Date	:	04/04/2022

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Directions to “ DR. NATHAN RUSSELL CALL D.D.S” Practice Location

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