Provider Demographics
NPI:1528184066
Name:RUSSELL, MY CHAU ELIZABETH (RDH)
Entity Type:Individual
Prefix:
First Name:MY CHAU
Middle Name:ELIZABETH
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MY CHAU
Other - Middle Name:ELIZABETH
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:2213 HUNTERS RUN DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-4799
Mailing Address - Country:US
Mailing Address - Phone:972-762-2852
Mailing Address - Fax:
Practice Address - Street 1:8608 PRESTON RD
Practice Address - Street 2:SUITE 112
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3316
Practice Address - Country:US
Practice Address - Phone:214-619-6329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12680124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist