Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 30.025455 | OH |
NPI | 1033513296 |
---|---|
Provider Name | Dr. Nicholas Russell |
First Address | Columbus, OH 43201-3771 |
Second Address | Columbus, OH 43230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2014 |
Last Update Date | 02/10/2018 |