Mark William Russell, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11836 Issued in NC

Practice address

2815 Village Way
Trent Woods, NC 28562-7351

Phone

(252) 633-4444

NPI assigned

May 1, 2020

Last updated

Jun 3, 2022By 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Mark W. Russell, DMD, PLLC

  dba Russell Family Dentistry

  • General Practice Dentistry
  • Trent Woods, NC
  • NPI 1487390662
  NPD Authorized official

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

{
    "created_epoch": "1588291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654214400000",
    "number": "1831710771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2815 VILLAGE WAY",
            "city": "TRENT WOODS",
            "state": "NC",
            "postal_code": "285627351",
            "telephone_number": "910-638-8413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2815 VILLAGE WAY",
            "city": "TRENT WOODS",
            "state": "NC",
            "postal_code": "285627351",
            "telephone_number": "252-633-4444"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "461 Western Blvd Ste 104",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "NC",
            "postal_code": "285467637",
            "country_code": "US",
            "telephone_number": "910-346-2202",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1951B Cambria Dr",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "NC",
            "postal_code": "278340094",
            "country_code": "US",
            "telephone_number": "910-638-8413",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "MARK",
        "middle_name": "WILLIAM",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-01",
        "last_updated": "2022-06-03",
        "certification_date": "2022-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "11836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "info@RussellFamilyDentist.com",
            "affiliation": "N",
            "address_1": "2815 Village Way",
            "city": "Trent Woods",
            "state": "NC",
            "country_code": "US",
            "postal_code": "285627351",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jasmin Denise Miles, LCMHCA
• Jasmine B Murphy, BSN, RN, IBCLC
• Kimberly Lewis Oncavage, O.D.
• Patrick M. McDonough, D.D.S., M.S., P.a. (Carolina Center for Dental Implants and Periodontics)
• Maria Scalf Priest, MSW, LCSW, LCAS-A
• Stephanie Scott, OTR-L
• William Andrew Seman, PH.D.
• Jolie Ann Stadelman, PA-C
• Alexandria Bonicelli Taylor
• Kathryn Taylor

• General Practice Dentistry in Trent Woods, NC
• Providers in Trent Woods, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2022; 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.