Provider Demographics
NPI:1326005299
Name:FRASER, RUSSELL MCNEIL (DMD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:MCNEIL
Last Name:FRASER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 ASHE BLVD
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-1729
Mailing Address - Country:US
Mailing Address - Phone:256-383-1499
Mailing Address - Fax:256-383-9135
Practice Address - Street 1:398 ASHE BLVD
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-1729
Practice Address - Country:US
Practice Address - Phone:256-383-1499
Practice Address - Fax:256-383-9135
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLNO30991223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT68697Medicare UPIN