Provider Demographics
NPI:1942366406
Name:DODD, RUSSELL M (DDS)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:M
Last Name:DODD
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 1:10912 COLONEL GLENN RD
Mailing Address - Street 2:SUITE 3500
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-8010
Mailing Address - Country:US
Mailing Address - Phone:501-568-6253
Mailing Address - Fax:
Practice Address - Street 1:10912 COLONEL GLENN RD
Practice Address - Street 2:SUITE 3500
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-8010
Practice Address - Country:US
Practice Address - Phone:501-568-6253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2981122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist