Travis Andre Russell, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

14607 Issued in NC

Practice address

280 Concord Pkwy S Ste 110a
Concord, NC 28027-2704

Phone

(704) 920-1070

Fax

(704) 920-1071

NPI assigned

Sep 17, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/BACCCD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Caresouth Carolina, Inc.

  • Federally Qualified Health Center (FQHC)
  • Hartsville, SC
  • NPI 1720082571
  Medicare reassignment NPD
• Caresouth Carolina, Inc

  • Federally Qualified Health Center (FQHC)
  • Society Hill, SC
  • NPI 1194763714
  NPD
• Caresouth Carolina Inc

  • Federally Qualified Health Center (FQHC)
  • Society Hill, SC
  • NPI 1174833511
  NPD (past)

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

{
    "created_epoch": "1537142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784851200000",
    "number": "1861976839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 MOORESVILLE RD",
            "city": "KANNAPOLIS",
            "state": "NC",
            "postal_code": "280810304",
            "telephone_number": "704-920-1000",
            "fax_number": "704-934-4270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 CONCORD PKWY S STE 110A",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280272704",
            "telephone_number": "704-920-1070",
            "fax_number": "704-920-1071"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Mooresville Rd",
            "address_purpose": "LOCATION",
            "city": "Kannapolis",
            "state": "NC",
            "postal_code": "280810304",
            "country_code": "US",
            "telephone_number": "704-920-1070",
            "fax_number": "704-920-1071",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "TRAVIS",
        "middle_name": "ANDRE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-17",
        "last_updated": "2026-07-24",
        "certification_date": "2026-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "SC",
            "license": "9255",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "14607",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX9255",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alisa Russell, M.S.
• Ann Russell, LCMHC
• Jessica D. Russell, M. ED, LPCA
• Jillian Marie Russell, MS CCC-SLP
• Mary C. Russell, MD
• Scott Gregory Rusteikas, DO
• Abigail L. Rutkai, LCSW
• Dashaunda Rutledge
• RX Central, Inc.
• Jamie K Ryan

• General Practice Dentistry in Concord, NC
• Providers in Concord, 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 Jul 24, 2026; 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.

Verify at the official NPI Registry.