Provider Demographics
NPI:1740045699
Name:RUSSELL HILL DENTAL ASSOCIATES PLLC
Entity type:Organization
Organization Name:RUSSELL HILL DENTAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VIDAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-729-5041
Mailing Address - Street 1:955 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-4302
Mailing Address - Country:US
Mailing Address - Phone:781-729-5041
Mailing Address - Fax:
Practice Address - Street 1:955 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-4302
Practice Address - Country:US
Practice Address - Phone:781-729-5041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental