Provider Demographics
NPI:1851602551
Name:RUSSELL, ALEXIS (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 TULANE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-7445
Mailing Address - Country:US
Mailing Address - Phone:504-304-9929
Mailing Address - Fax:504-304-6517
Practice Address - Street 1:2504 TULANE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7445
Practice Address - Country:US
Practice Address - Phone:504-304-9929
Practice Address - Fax:504-304-6517
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA60831223G0001X, 1223P0221X
NV72801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral Practice