Provider Demographics
NPI:1992829030
Name:RUSSELL, DAVID SCOTT (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
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 1:3819 NE 45TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5144
Mailing Address - Country:US
Mailing Address - Phone:206-524-6116
Mailing Address - Fax:206-528-0406
Practice Address - Street 1:3819 NE 45TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5144
Practice Address - Country:US
Practice Address - Phone:206-524-6116
Practice Address - Fax:206-528-0406
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA06021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice