Russell John Smith, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00006071 Issued in WA

Practice address

7209 265TH St NW
Suite 201
Stanwood, WA 98292-6292

Phone

(369) 629-3133

NPI assigned

May 15, 2007

Last updated

Jul 8, 2007By the provider in NPPES

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

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

• Joseph Eidsness, DDS, PLLC

  dba Port Susan Dental

  • Dental Clinic/Center
  • Stanwood, WA
  • NPI 1861290553
  NPD (past)

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1255547386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7209 265TH ST NW",
            "address_2": "SUITE 201",
            "city": "STANWOOD",
            "state": "WA",
            "postal_code": "982926292",
            "telephone_number": "369-629-3133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7209 265TH ST NW",
            "address_2": "SUITE 201",
            "city": "STANWOOD",
            "state": "WA",
            "postal_code": "982926292",
            "telephone_number": "369-629-3133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "RUSSELL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00006071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Skagit Valley Medical Center
• Skagit Valley Medical Center, Inc PS
• Suzanne Elizabeth Skegrud, LMP
• Sleep Care Inc
• Marleshia Michelle Smith, LMP
• Stefanie Joyce Smith, RN
• Tara Jean Smith, MT-BC
• Snohomish County Fire Protection Di District Unit 19
• Snohomish County Fire Protection District 14
• Snohomish County Fire Protection District 18

• General Practice Dentistry in Stanwood, WA
• Providers in Stanwood, WA by specialty
• General Practice Dentistry in Washington

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.