Provider Demographics
NPI:1275698789
Name:TRIPP, RUSSELL GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:GEORGE
Last Name:TRIPP
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 1:28W530 BATAVIA RD
Mailing Address - Street 2:PO BOX 291
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3022
Mailing Address - Country:US
Mailing Address - Phone:630-393-4600
Mailing Address - Fax:630-393-4690
Practice Address - Street 1:28W530 BATAVIA RD
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3022
Practice Address - Country:US
Practice Address - Phone:630-393-4600
Practice Address - Fax:630-393-4690
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist