Active NPI
Zachary D Russell, DDS
- Prosthodontics
- Schofield Barracks, HI
National Provider Identifier
1619032836
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- DT-2405
- Practice address
- 344 Heard Street
Building 556
Schofield Barracks, HI 96857 - Phone
- (808) 438-5555
- NPI assigned
- Dec 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 7062 | AZ | |
| General Practice Dentistry | 1223G0001X | DT-2405 | HI | |
| Prosthodontics | 1223P0700X | DT-2405 | HI | Primary |
Addresses
Primary practice location
344 Heard Street
Building 556
Schofield Barracks, HI 96857
Mailing address
334 Heard Ave
Building 556
Schofield Barracks, HI 96857
Phone (808) 438-5555
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 156326 | Other | AZ | AHCCCS ID# |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7062 | AZ | MD | Chiropractor |
| DT-2405 | HI | MD | Prosthodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Care for Kids of Arizona, LLC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Arizona's Kids Dental
- Orthodontics and Dentofacial Orthopedics Dentistry
- Phoenix, AZ
- NPI 1134269269
General Practice
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682640000000",
"number": "1619032836",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "334 HEARD AVE",
"address_2": "BUILDING 556",
"city": "SCHOFIELD BARRACKS",
"state": "HI",
"postal_code": "96857",
"telephone_number": "808-438-5555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "344 HEARD STREET",
"address_2": "BUILDING 556",
"city": "SCHOFIELD BARRACKS",
"state": "HI",
"postal_code": "96857",
"telephone_number": "808-438-5555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "ZACHARY",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-27",
"last_updated": "2023-04-28",
"certification_date": "2023-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "7062",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "HI",
"license": "DT-2405",
"primary": false
},
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "HI",
"license": "DT-2405",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AHCCCS ID#",
"identifier": "156326",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Schofield Barracks, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 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.