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KENNETH R. RUSSELL D.D.S. PA NPI 1902081094


NPI Information

NPI: 1902081094
Provider Name: KENNETH R,. RUSSELL, D.D.S. PA
Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
1480 RYMCO DR STE B
WINSTON SALEM, NC
ZIP 27103
Phone: (336) 768-7940
Get Directions

KENNETH R,. RUSSELL, D.D.S. PA is a general practice dentist in Winston Salem, NC. 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. KENNETH R,. RUSSELL, D.D.S. PA NPI is 1902081094. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

1480 RYMCO DR STE B
WINSTON SALEM, NC
ZIP 27103-944
Phone: (336) 768-7940
Fax: (336) 768-5985

The provider's authorized official is Kenneth Ray Russell .
The authorized official title is President and has the following contact phone number (336) 768-7940.

The enumeration date for this NPI number is 1/8/2008 and was last updated on 1/8/2008.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223G0001XDentistGeneral Practice5843NORTH CAROLINAYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1890195BMEDICAIDNORTH CAROLINA

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

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