Provider Demographics
NPI:1689824823
Name:RUSSELL M. DODD, DDS, P.C.
Entity Type:Organization
Organization Name:RUSSELL M. DODD, DDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:M
Authorized Official - Last Name:DODD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-568-6253
Mailing Address - Street 1:10912 COLONEL GLENN RD
Mailing Address - Street 2:SUITE 3500
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-8010
Mailing Address - Country:US
Mailing Address - Phone:501-568-6253
Mailing Address - Fax:501-568-5877
Practice Address - Street 1:10912 COLONEL GLENN RD
Practice Address - Street 2:SUITE 3500
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-8010
Practice Address - Country:US
Practice Address - Phone:501-568-6253
Practice Address - Fax:501-568-5877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2981122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty