Provider Demographics
NPI:1083029086
Name:RUSSELL, ASHLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 FOREST BROOK RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-8214
Mailing Address - Country:US
Mailing Address - Phone:251-656-4951
Mailing Address - Fax:
Practice Address - Street 1:1103 CALLAHAN DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-1310
Practice Address - Country:US
Practice Address - Phone:865-859-0355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL61101223G0001X, 122300000X
TX338911223P0221X
TN109761223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist