Provider Demographics
NPI:1144110057
Name:RUSSELL, ALEXANDRA LEIGH (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:LEIGH
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 1:2549 WALTON WAY APT D1
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4578
Mailing Address - Country:US
Mailing Address - Phone:478-244-5102
Mailing Address - Fax:
Practice Address - Street 1:545 MULLINS COLONY DR
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-0559
Practice Address - Country:US
Practice Address - Phone:706-842-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1238381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice