Provider Demographics
NPI:1851769111
Name:RUSSELL, LOUIS JR (DDS)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:RUSSELL
Suffix:JR
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 1:29210 QUINN RD
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4486
Mailing Address - Country:US
Mailing Address - Phone:281-351-5458
Mailing Address - Fax:
Practice Address - Street 1:29210 QUINN RD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4486
Practice Address - Country:US
Practice Address - Phone:281-351-5458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX181521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice