Provider Demographics
NPI:1932105087
Name:TANKERSLEY, RUSSELL K (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:K
Last Name:TANKERSLEY
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 1:8305 WALNUT HILL LN
Mailing Address - Street 2:STE 230
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4260
Mailing Address - Country:US
Mailing Address - Phone:214-368-5224
Mailing Address - Fax:214-368-1740
Practice Address - Street 1:8305 WALNUT HILL LN
Practice Address - Street 2:STE 230
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4260
Practice Address - Country:US
Practice Address - Phone:214-368-5224
Practice Address - Fax:214-368-1740
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX158771223G0001X
TX427124Q00000X
TX12440124Q00000X
TX126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered124Q00000XDental ProvidersDental Hygienist
Not Answered126800000XDental ProvidersDental Assistant