KEITH EDMUND RUSSELL DMD NPI 1447328752

NPI Information

NPI: 1447328752
Provider Name: KEITH EDMUND RUSSELL, DMD
Classification: Dentist - 1223G0001X
Entity Type: Individual

Specialization: General Practice

Address:
495 WOODFORD ST
PORTLAND, ME
ZIP 04103
Phone: (207) 772-6966
Get Directions

Keith Edmund Russell, DMD is a general practice dentist in Portland, ME. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. Keith Edmund Russell, DMD NPI is 1447328752. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

495 WOODFORD ST
PORTLAND, ME
ZIP 04103-438
Phone: (207) 772-6966
Fax: (207) 761-0756

The enumeration date for this NPI number is 12/4/2006 and was last updated on 3/20/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	122300000X	Dentist		3414	MAINE	No
2	1223G0001X	Dentist	General Practice	3414	MAINE	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	264030099	MEDICAID	MAINE
2	043377401	OTHER	MAINE	INDIVIDUAL TAX ID #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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