Eric Gordon Russell, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7301384-9922 Issued in UT

Practice address

4465 S 900 E Ste 100
Salt Lake City, UT 84124-2695

Phone

(801) 281-0100

NPI assigned

May 29, 2018

Last updated

May 29, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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.

• Eric G Russell DDS LLC

  • Dental Clinic/Center
  • Ogden, UT
  • NPI 1003462292
  NPD (past) Authorized official
• Andy Geigle PLLC

  dba Four Seasons Dental

  • Dental Clinic/Center
  • Millcreek, UT
  • NPI 1285571828
  NPD (past)
• Four Seasons Dental LLC

  • General Practice Dentistry
  • Salt Lake City, UT
  • NPI 1417305483
  NPD (past)

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

{
    "created_epoch": "1527552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527552000000",
    "number": "1558852269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2320 E LAMBOURNE AVE",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841092708",
            "telephone_number": "801-644-4605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4465 S 900 E STE 100",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841242695",
            "telephone_number": "801-281-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "ERIC",
        "middle_name": "GORDON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-05-29",
        "last_updated": "2018-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "7301384-9922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lydia Russell-Frey
• Alexander Russell
• Amy Bonifay Russell, PSY. D.
• Connie Russell
• Diane R Russell, FNP
• John Mark Russell, MD
• Lauren C Russell
• Leslie S Russell, CSW
• Madeline Grace Russell
• Roger T Russell

• General Practice Dentistry in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2018; 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.