Travis Ray Russell, DDS
Dentist in Mc Kenzie, TN. Individual provider (NPI-1).
NPI number1679001085
StatusActive
Last updated in NPPESMay 30, 2017
Details
- NPI
- 1679001085
- Entity type
- Individual (NPI-1)
- Name
- Travis Ray Russell
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 30, 2017
- Last updated
- May 30, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 10509 | TN | Yes |
Practice location
594 Main St NMc Kenzie, TN 38201-1707
Phone 731-415-3084
Mailing address
594 Main St NMc Kenzie, TN 38201-1707
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