Russell, Brett V

Russell, Brett V is an sole proprietor health care provider with primary practice located at 2310 Forum Blvd Suite A, Columbia MO 65203-5461. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Russell, Brett V can be contacted via phone (573) 446-0032.

Contact Information

Primary practice address
2310 Forum Blvd Suite A Columbia MO 65203-5461
Phone: (573) 446-0032
Fax: (573) 446-0238
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 12933 Missouri

Profile Details

NPI number 1306053988
LBN Legal business name Russell, Brett V
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 16th, 2007
Last updated Jun 16th, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306053988 NPPES
Missouri Other 103550 BLUE CROSS BLUE SHIELD
Missouri Other 860382 BLUE CROSS BLUE SHIELD

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