Provider Demographics
NPI:1427820968
Name:RUSSELL C PARKER DMD PLLC
Entity type:Organization
Organization Name:RUSSELL C PARKER DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-350-5006
Mailing Address - Street 1:2012 DANVILLE PARK DR SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-1832
Mailing Address - Country:US
Mailing Address - Phone:256-350-5006
Mailing Address - Fax:
Practice Address - Street 1:2012 DANVILLE PARK DR SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-1832
Practice Address - Country:US
Practice Address - Phone:256-350-5006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALD.007168-COtherBOARD OF DENTAL EXAMINERS OF ALABAMA