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DR. BRADLY KALB RUSSELL DDS NPI 1932490307


NPI Information

NPI: 1932490307
Provider Name: DR. BRADLY KALB RUSSELL, DDS
Classification: Dentist - 1223S0112X
Entity Type: Individual

Specialization: Oral and Maxillofacial Surgery

PECOS Registration: Yes

Address:
1601 S HAWTHORNE RD
WINSTON SALEM, NC
ZIP 27103
Phone: (336) 765-9550
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DR. Bradly Kalb Russell, DDS is an oral and maxillofacial surgery dentist in Winston Salem, NC. 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. Bradly Kalb Russell, DDS NPI is 1932490307. 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:

1601 S HAWTHORNE RD
WINSTON SALEM, NC
ZIP 27103-127
Phone: (336) 765-9550
Fax: (336) 765-9552

The NPI 1932490307 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 4/20/2011 and was last updated on 10/6/2021.


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
1390200000XStudent in an Organized Health Care Education/Training ProgramNo
21223S0112XDentistOral and Maxillofacial Surgery30.0239911OHIOYes
31223S0112XDentistOral and Maxillofacial Surgery11536NORTH CAROLINANo
41223S0112XDentistOral and Maxillofacial Surgery30-023991OHIONo

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.