Willard Dean Russell Jr., DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2483 Issued in WV

Practice address

1007 Sushruta Drive
Martinsburg, WV 25401

Phone

(304) 263-0991

Fax

(304) 274-9546

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 3

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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 and National Provider Directory roles.

• Associated Oral & Maxillofacial Surgeons, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Martinsburg, WV
  • NPI 1346310505
  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": "1338336000000",
    "number": "1215010285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 SUSHRUTA DRIVE",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "25401",
            "telephone_number": "304-263-0991",
            "fax_number": "304-274-9546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 SUSHRUTA DRIVE",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "25401",
            "telephone_number": "304-263-0991",
            "fax_number": "304-274-9546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "WILLARD",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2012-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WV",
            "license": "2483",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MD",
            "license": "6261",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "DS030508L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIGON",
            "identifier": "066637",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0136408000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MD",
            "identifier": "DF52",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL/MEDICAL",
            "identifier": "LK72",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather Renee Runion
• Rural Outreach Arthritis Center
• Celena Russ, NP
• Alexandra Russell
• Brittany Nicole Russell, LPC, NCC, CCMHC
• Lindsay Dawn Russo, MSW, LCSW-C
• Terry Myers Ruthrauff, PSYD
• Anita Ryan, LICSW
• Jacqueline Ryan, MS RD
• Philip J a Ryan, MD

• Oral and Maxillofacial Surgery (Dentist) in Martinsburg, WV
• Providers in Martinsburg, WV by specialty
• Oral and Maxillofacial Surgery (Dentist) in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2012; 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.