Provider Demographics
NPI:1659627693
Name:MARRINER RUSSELL MORRELL, DMD, PC
Entity Type:Organization
Organization Name:MARRINER RUSSELL MORRELL, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARRINER
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:MORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-277-6724
Mailing Address - Street 1:425 G. STREET
Mailing Address - Street 2:SUITE 730
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-2138
Mailing Address - Country:US
Mailing Address - Phone:907-277-6724
Mailing Address - Fax:907-677-3850
Practice Address - Street 1:425 G. STREET
Practice Address - Street 2:SUITE 730
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2138
Practice Address - Country:US
Practice Address - Phone:907-277-6724
Practice Address - Fax:907-677-3850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
AK10581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty