| Yellow Springs Dental Care John T Russell Dds Inc. | |
|
1030 Xenia Ave Yellow Springs OH 45387-1632 | |
| (937) 767-7731 | |
| Not Available |
| Full Name | Yellow Springs Dental Care John T Russell Dds Inc. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1030 Xenia Ave, Yellow Springs, Ohio |
| Authorized Official Name and Position | John T Russell (CLINICIAN) |
| Authorized Official Contact | 9377677731 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Yellow Springs Dental Care John T Russell Dds Inc. 1030 Xenia Ave Po Box 839 Yellow Springs OH 45387-1632 Ph: (937) 767-7731 | Yellow Springs Dental Care John T Russell Dds Inc. 1030 Xenia Ave Yellow Springs OH 45387-1632 Ph: (937) 767-7731 |
| NPI Number | 1568684140 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 05/19/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568684140 | NPI | - | NPPES |
| DN16600 | Other | FL | STATE |
| 1679511489 | Other | OH | NPI |
| 30.013562 | Other | OH | STATE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 30.013562 (Ohio) | Primary |
Yellow Springs Family Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1496 Southgate Ave, Yellow Springs, OH 45387 Phone: 937-767-8000 Fax: 937-767-2542 |