Provider Demographics
NPI:1326170127
Name:RUSSELL, WILLIAM A (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:RUSSELL
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 1:2002 NO UNIVERSITY
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207
Mailing Address - Country:US
Mailing Address - Phone:501-666-2876
Mailing Address - Fax:501-666-2875
Practice Address - Street 1:2002 NO UNIVERSITY
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207
Practice Address - Country:US
Practice Address - Phone:501-666-2876
Practice Address - Fax:501-666-2875
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR1580122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist