Active NPI
Lisa Marie Russell, D.M.D.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Hannibal, MO
National Provider Identifier
1700150976
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 2011028140
- Practice address
- 655 Clinic Rd
Suite 110
Hannibal, MO 63401-3647 - Phone
- (573) 221-0001
- NPI assigned
- Mar 5, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 2011028140 | MO | Primary |
Addresses
Primary practice location
655 Clinic Rd
Suite 110
Hannibal, MO 63401-3647
Mailing address
655 Clinic Rd
Suite 110
Hannibal, MO 63401-3647
Phone (573) 221-0001
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 |
|---|---|---|---|
| 2011028140 | MO | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330905600000",
"number": "1700150976",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "655 CLINIC RD",
"address_2": "SUITE 110",
"city": "HANNIBAL",
"state": "MO",
"postal_code": "634013647",
"telephone_number": "573-221-0001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "655 CLINIC RD",
"address_2": "SUITE 110",
"city": "HANNIBAL",
"state": "MO",
"postal_code": "634013647",
"telephone_number": "573-221-0001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "LISA",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-03-05",
"last_updated": "2012-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "MO",
"license": "2011028140",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hannibal, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.