Provider Demographics
NPI:1518962562
Name:FIFE, RUSSELL W (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:W
Last Name:FIFE
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 1:8100 LOMO ALTO DR
Mailing Address - Street 2:STE 160
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6530
Mailing Address - Country:US
Mailing Address - Phone:214-368-0018
Mailing Address - Fax:469-916-5044
Practice Address - Street 1:8100 LOMO ALTO DR
Practice Address - Street 2:STE 160
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6530
Practice Address - Country:US
Practice Address - Phone:214-368-0018
Practice Address - Fax:469-916-5044
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX141811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice