Provider Demographics
NPI:1689796765
Name:REMALEY, RUSSELL DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:DAVID
Last Name:REMALEY
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 1:1570 OLD ALABAMA RD.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2801
Mailing Address - Country:US
Mailing Address - Phone:770-998-6736
Mailing Address - Fax:
Practice Address - Street 1:1570 OLD ALABAMA RD.
Practice Address - Street 2:SUITE 102
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2801
Practice Address - Country:US
Practice Address - Phone:770-998-6736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA76301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice