Thomas Duckworth Russell IV, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6983 Issued in TN

Practice address

130 Peachtree PLZ
Brownsville, TN 38012-2500

Phone

(731) 772-2107

Fax

(731) 772-1710

NPI assigned

Oct 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Russell Dental Group, P.C.

  • General Practice Dentistry
  • Brownsville, TN
  • NPI 1942297643
  NPD (past)

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1144303025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 PEACHTREE PLZ",
            "city": "BROWNSVILLE",
            "state": "TN",
            "postal_code": "380122500",
            "telephone_number": "731-772-2107",
            "fax_number": "731-772-1710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 PEACHTREE PLZ",
            "city": "BROWNSVILLE",
            "state": "TN",
            "postal_code": "380122500",
            "telephone_number": "731-772-2107",
            "fax_number": "731-772-1710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "THOMAS",
        "middle_name": "DUCKWORTH",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "6983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany Richmond, APRN, FNP-BC
• Mary Phillips Roberts, PHARMD
• Robert N Rooks, DDS
• Russell Dental Group, P.C.
• Andrew David Russell, D.D.S.
• Thomas Duckworth Russell III, D.D.S.
• Mark Salenga
• Anika Powell Shaw, LCSW
• Silas D&a Enterprises LLC (SDA Learning Center)
• Antoinette Yvette Silas

• General Practice Dentistry in Brownsville, TN
• Providers in Brownsville, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.