Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 6110 | AL |
N | 1223G0001X | General Practice | 6110 | AL |
N | 213EG0000X | General Practice | 6110 | AL |
Y | 1223P0221X | Pediatric Dentist | 10976 | TN |
N | 1223P0221X | Pediatric Dentist | 33891 | TX |
NPI | 1083029086 |
---|---|
Provider Name | Dr. Ashley Russell |
First Address | Knoxville, TN 37919-8214 |
Second Address | Knoxville, TN 37912-1310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2014 |
Last Update Date | 28/07/2019 |