NPIMap

Organization Active NPI

Russell Dental Group, P.C.

  • General Practice Dentistry
  • Brownsville, TN
National Provider Identifier
1942297643
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2338 Issued in TN
Legal business name
RUSSELL DENTAL GROUP, P.C.
Practice address
130 Peachtree PLZ
Brownsville, TN 38012-2500
Phone
(731) 772-2107
NPI assigned
Sep 29, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Thomas Duckworth Russell III, D.D.S.
Title
Corporation President, Dentist
Phone
(731) 772-2107

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 2338 TN Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 7764 TN
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 6983 TN

Addresses

Primary practice location

130 Peachtree PLZ
Brownsville, TN 38012-2500

Mailing address

130 Peachtree PLZ
Brownsville, TN 38012-2500
Phone (731) 772-2107

Other identifiers 1

IdentifierTypeStateIssuer
014423OtherTNTENNCARE

National Provider Directory

National Provider Directory

Locations

130 Peachtree Plz
Brownsville, TN 38012
Phone (731) 772-2107

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942297643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 PEACHTREE PLZ",
            "city": "BROWNSVILLE",
            "state": "TN",
            "postal_code": "380122500",
            "telephone_number": "731-772-2107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 PEACHTREE PLZ",
            "city": "BROWNSVILLE",
            "state": "TN",
            "postal_code": "380122500",
            "telephone_number": "731-772-2107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELL DENTAL GROUP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RUSSELL III",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "DUCKWORTH",
        "authorized_official_title_or_position": "CORPORATION PRESIDENT, DENTIST",
        "authorized_official_telephone_number": "731-772-2107",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "2338",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "7764",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "6983",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TENNCARE",
            "identifier": "014423",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brownsville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.