| NPI | 1003151390 |
|---|---|
| Doing Business As | RICKY DALE RUSSELL, DDS |
| Entity Type | Organization |
| Authorized Contact | RICKY DALE RUSSELL Owner 615-459-8050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2012-11-28 |
| Last Update Date | 2012-11-28 |