Russell Walther, DDS, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DN 21651 Issued in FL

Practice address

2648 Centennial PL
Tallahassee, FL 32308-0572

Phone

(850) 523-3000

Fax

(850) 523-0831

NPI assigned

Mar 24, 2010

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Red Hills Oral and Facial Surgery, PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Tallahassee, FL
  • NPI 1427660703
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1269388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471996800000",
    "number": "1073837746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2648 CENTENNIAL PL",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323080572",
            "telephone_number": "850-523-3000",
            "fax_number": "850-523-0831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2648 CENTENNIAL PL",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323080572",
            "telephone_number": "850-523-3000",
            "fax_number": "850-523-0831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTHER",
        "first_name": "RUSSELL",
        "credential": "DDS, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-24",
        "last_updated": "2016-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN 21651",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "ME 126426",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suzannah McKenzie Walsh, COTA/L
• Walter Hathaway, O.D.
• Breanna Jameson Walters, MD
• Jordan Daniel Walters, MD
• Kirstin Walther, DMD
• James Franklin Walton III, DDS
• Stephen Carl Waltz, M.S.., L.M.F.T.
• Hannah Walz, OTR/L
• Sarah Wanamaker, PHARMD
• Amari Wanzer

• Oral and Maxillofacial Surgery (Dentist) in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.