Mr. Mike A. Russell DDS
General Practice Dentistry in Baton Rouge, LA(View on Map)
Full Name
Mr. Mike August Russell DDS
NPI Number
1235214552
NPI Type
Individual Provider
Gender
Male
Enumeration Date
10/26/2006
Specialties
(Taxonomies)Licenses
State
Louisiana
License Number
LA4375
Contact
Information
Purpose
Mailing
Location
Address
7355 LATIMER DRIVE
6721 GOVERNMENT STREET
City
Denham Springs
Baton Rouge
State
LA
LA
Postal Code
70726
70806
Country
US
US
Telephone Number
(225) 667-2151
(225) 924-2636
Identifiers
Identifier
1843750
F1517
Identifier State
LA
LA
Identifier Issuer
Unknown
BLUE CROSS BLUE SHIELD
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 07/08/2007
Provider Address
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