Provider Demographics
NPI:1811271513
Name:BEGGS, RUSSELL J (DMD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:J
Last Name:BEGGS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 TROUT GULCH RD
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3920
Mailing Address - Country:US
Mailing Address - Phone:831-688-7262
Mailing Address - Fax:831-688-6015
Practice Address - Street 1:410 TROUT GULCH RD
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3920
Practice Address - Country:US
Practice Address - Phone:831-688-7262
Practice Address - Fax:831-688-6015
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA311621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice