Keith Edmund Russell is a Portland, Maine based Dentist who is specialized in Dentistry. He does not accept the Medicare-approved amount. Patients will be billed for the treatment. Active license number of Keith Edmund Russell is 3414 for General Practice Dentistry in Maine. His current practice location is 495 Woodford St, Portland. Patients can reach him at 207-772-6966.
Keith Edmund Russell is the primary dental care provider for patients of all ages. He is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
Complete Profile:
Keith Edmund Russell speciality, credentials, practice address, contact phone number and fax are as below.
Patients can directly walk in or can call on the below given phone number for appointment.
Name:
Keith Edmund Russell
Specialization:
Dentist
Gender:
Male
Credentials:
DMD
Accepts Medicare Assignment:
No
Practice Address:
495 Woodford St, Portland, Maine, 04103-2438
Phone:
207-772-6966
Fax:
207-761-0756
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details are as mentioned below.
NPI Number:
1447328752
NPI Enumeration Date:
04 Dec, 2006
NPI Last Update On:
20 Mar, 2023
Medical Licenses:
Doctors can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Keith Edmund Russell are as mentioned below.
License Number
Specialization
State
Status
3414
General Practice Dentistry
Maine
Primary
3414
Dentistry
Maine
Secondary
Other Medical Identifiers:
Other legacy medical identifiers associated with Keith Edmund Russell such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
Identifier
Type
State
Issuer
264030099
Medicaid
Maine
043377401
Other
Maine
INDIVIDUAL TAX ID #
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
Address:
495 Woodford St, Portland, Maine
Zip:
04103-2438
Phone Number:
207-772-6966
Patients can reach Keith Edmund Russell at 495 Woodford St, Portland, Maine or can call to book an appointment on 207-772-6966. Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 09 September, 2024.