Provider Demographics
NPI:1942332747
Name:RUSSELL, J. CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:J. CHRISTOPHER
Middle Name:
Last Name:RUSSELL
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 1:3302 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5905
Mailing Address - Country:US
Mailing Address - Phone:562-438-9486
Mailing Address - Fax:562-438-0152
Practice Address - Street 1:3302 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5905
Practice Address - Country:US
Practice Address - Phone:562-438-9486
Practice Address - Fax:562-438-0152
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice