Provider Demographics
NPI:1962713289
Name:WARBURTON, RUSSELL ERIC (MD, DMD)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:ERIC
Last Name:WARBURTON
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2493
Mailing Address - Country:US
Mailing Address - Phone:828-255-7781
Mailing Address - Fax:828-258-3770
Practice Address - Street 1:4 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2493
Practice Address - Country:US
Practice Address - Phone:828-255-7781
Practice Address - Fax:828-258-3770
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN102411223S0112X
TN54513204E00000X
NC2017-02428204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery