William Dirk Russell, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN012158 Issued in KY

Practice address

8014 Cumming Hwy Suite 401
Canton, GA 30115

Phone

(770) 345-2010

Fax

(770) 345-0571

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dirk W Russell Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Dirk Russell D.M.D., P.C.

  • General Practice Dentistry
  • Canton, GA
  • NPI 1689754202

  General Practice

  NPD (past)

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1114007887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8014 CUMMING HWY SUITE 401",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "30115",
            "telephone_number": "770-345-2010",
            "fax_number": "770-345-0571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8014 CUMMING HWY SUITE 401",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "30115",
            "telephone_number": "770-345-2010",
            "fax_number": "770-345-0571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "WILLIAM DIRK",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "DN012158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIRK",
            "last_name": "RUSSELL",
            "middle_name": "W",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jose Benjamin Ruiz-Lagos, M.D.
• Jordan S Rush, MD
• Kristen Marie Rusher
• Andrea W. Russell, D.M.D.
• Carl M. Russell, DMD, PHD
• James Michael Rutherford, CRNA
• Terri Rybak, CST/CSFA
• Samuel M Sabaka, PH.D.
• Najam Sabreen, MD
• Jennifer-Linda S Saccoccia, MS, NCC, LAPC

• General Practice Dentistry in Canton, GA
• Providers in Canton, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.