Mike August Russell, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

LA4375 Issued in LA

Practice address

6721 Government Street
Suite a
Baton Rouge, LA 70806

Phone

(225) 924-2636

Fax

(225) 924-4424

NPI assigned

Oct 26, 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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235214552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7355 LATIMER DRIVE",
            "city": "DENHAM SPRINGS",
            "state": "LA",
            "postal_code": "70726",
            "telephone_number": "225-667-2151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6721 GOVERNMENT STREET",
            "address_2": "SUITE A",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "70806",
            "telephone_number": "225-924-2636",
            "fax_number": "225-924-4424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "MIKE",
        "middle_name": "AUGUST",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "LA4375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1843750",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "F1517",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Briana R Russell
• Carley Hand Russell, MS, BCBA
• Danielle Rebecca Russell
• Emonya Russell
• Kathleen McCraney Brown Russell
• Randall Shane Russell
• Shandricka Russell, LPC
• William E Russell, M.D.
• Aimee Russo-Mounger, DDS
• Aldo J Russo, M.D.

• General Practice Dentistry in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• General Practice Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.