Stephen Dickinson Russell Jr., D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

DE00010316 Issued in WA

Practice address

2604 Yelm Hwy SE
Olympia, WA 98501-4820

Phone

(360) 915-9832

NPI assigned

Aug 2, 2006

Last updated

Sep 10, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 1, 2023 through Nov 1, 2027

Medicare enrollment (NPD)

Enrolled

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.

• S. Russell & Russell, PLLC

  • Dentist
  • Tumwater, WA
  • NPI 1548416159
  NPD (past)

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1750398426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2604 YELM HWY SE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985014820",
            "telephone_number": "360-915-9832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2604 YELM HWY SE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985014820",
            "telephone_number": "360-915-9832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "STEPHEN",
        "middle_name": "DICKINSON",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00010316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Russell, LPN
• Jolene R Russell, BA LMP
• Matthew Richard Russell, M.D.
• Robert D Russell, M.D.
• Shannon Russell, LMHC
• Sunny R Russell
• Monica Irene Rutledge
• Christopher Rutzer
• Ryan D Womack MD DDS PLLC (Capital Oral & Maxillofacial Surgery)
• Ryan Wathne PLLC

• Dentist in Olympia, WA
• Providers in Olympia, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.