Provider Demographics
NPI:1295817229
Name:RUSSELL, CYNTHIA CLAIR (DDS)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:CLAIR
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 LEAVENWORTH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-1438
Mailing Address - Country:US
Mailing Address - Phone:402-553-4008
Mailing Address - Fax:402-553-8848
Practice Address - Street 1:5017 LEAVENWORTH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-1438
Practice Address - Country:US
Practice Address - Phone:402-553-4008
Practice Address - Fax:402-553-8848
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5281122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist