Provider Demographics
NPI:1033784863
Name:PARKIN, RUSSELL RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:RICHARD
Last Name:PARKIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4046 S HIGHLAND DR STE 113
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1689
Mailing Address - Country:US
Mailing Address - Phone:801-272-9003
Mailing Address - Fax:
Practice Address - Street 1:4046 S HIGHLAND DR STE 113
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84124-1689
Practice Address - Country:US
Practice Address - Phone:801-272-9003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12316860-9923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist