Provider Demographics
NPI:1477635076
Name:RUSSELL, STEPHEN K (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:K
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 1:9501 NORTH OAK
Mailing Address - Street 2:SUITE 205
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155
Mailing Address - Country:US
Mailing Address - Phone:816-436-2242
Mailing Address - Fax:816-436-5435
Practice Address - Street 1:9501 NORTH OAK
Practice Address - Street 2:SUITE 205
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155
Practice Address - Country:US
Practice Address - Phone:816-436-2242
Practice Address - Fax:816-436-5435
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO147151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice