Keith Edmund Russell, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3414 Issued in ME

Practice address

495 Woodford St
Portland, ME 04103-2438

Phone

(207) 772-6966

Fax

(207) 761-0756

NPI assigned

Dec 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Russell Family Dentistry LLC

  • General Practice Dentistry
  • Portland, ME
  • NPI 1659449940
  NPD Authorized official

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679270400000",
    "number": "1447328752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "495 WOODFORD ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041032438",
            "telephone_number": "207-772-6966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 WOODFORD ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041032438",
            "telephone_number": "207-772-6966",
            "fax_number": "207-761-0756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "KEITH",
        "middle_name": "EDMUND",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-04",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ME",
            "license": "3414",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ME",
            "license": "3414",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "264030099",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL TAX ID #",
            "identifier": "043377401",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Devin Russell
• Emily B. Russell, LCSW
• Erich Russell, D.O
• George H Russell, MD
• J. Maxwell Russell IV, DO
• Marlena Russell
• Rachel Russell, FNP-C
• Tina Russell, LMT
• Susan J Russett-Collett, DDS
• Brett Russman, LCSW

• General Practice Dentistry in Portland, ME
• Providers in Portland, ME by specialty
• General Practice Dentistry in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2023; 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.