Emilie Caron Russell, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4201-21 Issued in MS

Practice address

101 Park Gate Dr
Tupelo, MS 38801-3033

Phone

(662) 840-1535

Fax

(662) 844-3823

NPI assigned

Sep 16, 2021

Sex

Female

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Tupelo Smiles Family and Cosmetic Dentistry

  • General Practice Dentistry
  • Tupelo, MS
  • NPI 1134246630
  NPD (past)

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

{
    "created_epoch": "1631750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631750400000",
    "number": "1992475438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 PARK GATE DR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388013033",
            "telephone_number": "662-840-1535",
            "fax_number": "662-844-3823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 PARK GATE DR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388013033",
            "telephone_number": "662-840-1535",
            "fax_number": "662-844-3823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "EMILIE",
        "middle_name": "CARON",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-16",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "4201-21",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• RPG Medical of North Mississippi LLC
• Rrti 2 LLC
• Balfour William Ruff III, M.ED.
• Gabriel Job Rulewicz, MD
• Brady Russell
• Noah Russell, DO
• Ryan D Russell, O.D.
• Wesley Guy Russell, CRNA
• RXS PM Retail
• RXS Tupelo, LLC

• General Practice Dentistry in Tupelo, MS
• Providers in Tupelo, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2021; 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.