NPIMap

Organization Active NPI

Russell Family Dentistry LLC

  • General Practice Dentistry
  • Portland, ME
National Provider Identifier
1659449940
Registry record updated May 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
RUSSELL FAMILY DENTISTRY LLC
Practice address
495 Woodford Street
Portland, ME 04103
Phone
(207) 772-6966
Fax
(207) 761-0756
NPI assigned
Dec 3, 2006
Last updated
May 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2023

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

Authorized official

Name
Keith Edmund Russell, D.M.D.NPI 1447328752
Title
Member/Dentist
Phone
(207) 772-6966

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

495 Woodford Street
Portland, ME 04103

Mailing address

495 Woodford Street
Portland, ME 04103
Phone (207) 772-6966

Other identifiers 1

IdentifierTypeStateIssuer
154630000OtherMEMAINE CARE

Other names 1

  • Regan & Russell LLC Former legal business name

National Provider Directory

National Provider Directory

Locations

495 Woodford St
Portland, ME 04103
Phone (207) 772-6966

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1165104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683849600000",
    "number": "1659449940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "495 WOODFORD STREET",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04103",
            "telephone_number": "207-772-6966",
            "fax_number": "207-761-0756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 WOODFORD STREET",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04103",
            "telephone_number": "207-772-6966",
            "fax_number": "207-761-0756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELL FAMILY DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-03",
        "last_updated": "2023-05-12",
        "certification_date": "2023-05-12",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "EDMUND",
        "authorized_official_title_or_position": "MEMBER/DENTIST",
        "authorized_official_telephone_number": "207-772-6966",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAINE CARE",
            "identifier": "154630000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Regan & Russell LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Portland, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 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.