Provider Demographics
NPI:1124044706
Name:RUSSELL, DONALD MARTIN (DDS ORTHODONTIST)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MARTIN
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:DDS ORTHODONTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4714 EDMONDSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229
Mailing Address - Country:US
Mailing Address - Phone:410-566-4200
Mailing Address - Fax:410-566-1770
Practice Address - Street 1:4714 EDMONDSON AVENUE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229
Practice Address - Country:US
Practice Address - Phone:410-566-4200
Practice Address - Fax:410-566-1770
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD49001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics