Provider Demographics
NPI:1043369333
Name:EYMAN, RUSSELL G (DDS, MS)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:G
Last Name:EYMAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CARL VINSON PKWY
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5831
Mailing Address - Country:US
Mailing Address - Phone:478-923-0232
Mailing Address - Fax:478-929-3382
Practice Address - Street 1:225 CARL VINSON PKWY
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5831
Practice Address - Country:US
Practice Address - Phone:478-923-0232
Practice Address - Fax:478-929-3382
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA74171223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU22278Medicare UPIN