Eric G Russell DDS LLC
Clinic/Center, Dental in Ogden, UT. Organization (NPI-2).
NPI number1003462292
StatusActive
Last updated in NPPESAug 13, 2019
Details
- NPI
- 1003462292
- Entity type
- Organization (NPI-2)
- Legal business name
- Eric G Russell DDS LLC
- Organization subpart
- No
- Enumeration date
- Aug 13, 2019
- Last updated
- Aug 13, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Practice location
5685 S 1475 E Ste 4aOgden, UT 84403-4598
Phone 801-475-4646
Mailing address
5685 S 1475 E Ste 4aOgden, UT 84403-4598
Phone 801-475-4646
Authorized official
Eric Gordon Russell
Owner/Member Manager
8016444605
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