Grant Christian Russell, DMD

NPI #1366129223 in Godfrey, Illinois

Provider Information

NPI Number: 1366129223
Entity Type: Individual
Name: Grant Christian Russell, DMD
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dentist - General Practice
Credential: DMD
Enumeration Date: Jul 3, 2023
Last Updated: Jul 3, 2023

Practice Location

Address: 1203 W DELMAR AVE
City: Godfrey
State: Illinois
ZIP Code: 62035-1739
Phone: (618) 466-3140

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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