Provider Demographics
NPI:1326309253
Name:TRITAPOE, RUSSELL (DDS)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:TRITAPOE
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:PO BOX 738
Mailing Address - Street 2:
Mailing Address - City:FORT ASHBY
Mailing Address - State:WV
Mailing Address - Zip Code:26719-0738
Mailing Address - Country:US
Mailing Address - Phone:304-298-3501
Mailing Address - Fax:
Practice Address - Street 1:HC 63 BOX 3560
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-9722
Practice Address - Country:US
Practice Address - Phone:304-822-4447
Practice Address - Fax:304-822-7943
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3997122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist