Active NPI
Deborah Krystal Russell, D.M.D
- Dentist
- Windcrest, TX
National Provider Identifier
1760913156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 32521
- Practice address
- 5542 Walzem Rd
Windcrest, TX 78218-2103 - Phone
- (210) 922-7000
- Fax
- (210) 637-2484
- NPI assigned
- Mar 27, 2017
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 32521 | TX | Primary |
Addresses
Primary practice location
5542 Walzem Rd
Windcrest, TX 78218-2103
Mailing address
3750 Commercial Ave
San Antonio, TX 78221-3117
Phone (210) 922-7000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170516002943 | TX | Order and Referring Only - Dentist | 8325315633 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32514 | TX | MD | Counseling Psychologist |
| 32521 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1499817600000",
"number": "1760913156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3750 COMMERCIAL AVE",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782213117",
"telephone_number": "210-922-7000",
"fax_number": "210-637-2484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5542 WALZEM RD",
"city": "WINDCREST",
"state": "TX",
"postal_code": "782182103",
"telephone_number": "210-922-7000",
"fax_number": "210-637-2484"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "DEBORAH",
"middle_name": "KRYSTAL",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-27",
"last_updated": "2017-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "32521",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Windcrest, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2017; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.