DR. WILLARD DEAN RUSSELL DDS NPI 1215010285

NPI Information

NPI: 1215010285
Provider Name: DR. WILLARD DEAN RUSSELL, DDS
Classification: Dentist - 1223S0112X
Entity Type: Individual

Specialization: Oral and Maxillofacial Surgery

Address:
1007 SUSHRUTA DRIVE
MARTINSBURG, WV
ZIP 25401
Phone: (304) 263-0991
Get Directions

DR. Willard Dean Russell, DDS is an oral and maxillofacial surgery dentist in Martinsburg, WV. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. DR. Willard Dean Russell, DDS NPI is 1215010285. 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:

1007 SUSHRUTA DRIVE
MARTINSBURG, WV
ZIP 25401
Phone: (304) 263-0991
Fax: (304) 274-9546

The enumeration date for this NPI number is 10/23/2006 and was last updated on 5/30/2012.

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	1223S0112X	Dentist	Oral and Maxillofacial Surgery	6261	MARYLAND	No
2	1223S0112X	Dentist	Oral and Maxillofacial Surgery	DS030508L	PENNSYLVANIA	No
3	1223S0112X	Dentist	Oral and Maxillofacial Surgery	2483	WEST VIRGINIA	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	0136408000	MEDICAID	WEST VIRGINIA
2	DF52	OTHER	MARYLAND	BCBS MD
3	LK72	OTHER	MARYLAND	DENTAL/MEDICAL
4	066637	OTHER		TRIGON
5	RU0505372	MEDICARE ID-TYPE UNSPECIFIED	WEST VIRGINIA
6	T32335	MEDICARE UPIN

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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