Provider Demographics
NPI:1902215452
Name:RUSSELL AND BODE DDS PLLC
Entity Type:Organization
Organization Name:RUSSELL AND BODE DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUEHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-943-8182
Mailing Address - Street 1:2006 CATON WAY SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1119
Mailing Address - Country:US
Mailing Address - Phone:360-943-8182
Mailing Address - Fax:360-943-3433
Practice Address - Street 1:2006 CATON WAY SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1119
Practice Address - Country:US
Practice Address - Phone:360-943-8182
Practice Address - Fax:360-943-3433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10316122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty