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DR. RUSSELL G. ANDERSON JR. D.M.D.
NPI 1811068620
Dentist - General Practice in Kennesaw, GA

Active since November 13, 2006Opted out of Medicare · through Sep 6, 2026
1415 WOOTEN LAKE RD NW, SUITE 300, KENNESAW, GA 30144(770) 419-2535(770) 419-0030 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Russell G. Anderson Jr. D.m.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. RUSSELL G. ANDERSON JR. D.M.D. (NPI 1811068620) is an individual general practice provider in Kennesaw, Georgia, licensed in Georgia (011457) and active in the NPI registry since November 2006. He has opted out of Medicare through September 6, 2026.

NPPES Registry Identity

NPI1811068620
Entity TypeIndividualMale
Primary Taxonomy1223G0001X
Provider Legal NameDR. RUSSELL G. ANDERSON JR.Credential: D.M.D.
Location Address1415 WOOTEN LAKE RD NW, SUITE 300Kennesaw, GA 30144-1350
Mailing Address1415 Wooten Lake Rd Nw, Suite 300Kennesaw, GA 30144-1350 · (770) 419-2535 · Fax (770) 419-0030
Phone(770) 419-2535
Fax(770) 419-0030
Sole ProprietorYes
Enumeration DateNovember 13, 2006
Last NPPES UpdateJuly 8, 2007
✔ NPI 1811068620 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in GA · 011457
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
1415 WOOTEN LAKE RD NW, Kennesaw, GA 30144
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Russell G. Anderson Jr. D.m.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from September 6, 2018 through September 6, 2026.

Opt-Out Effective DateSeptember 6, 2018
Opt-Out In Effect ThroughSeptember 6, 2026Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RYAN CHIHIEN TIEU O.D.
Optometrist
1415 WOOTEN LAKE RD NW
KENNESAW, GA 30144
Cobb County (770) 792-3937
TASMAN EYE CONSULTANTS PC
Optometrist
1415 WOOTEN LAKE RD NW, SUITE 100
KENNESAW, GA 30144
Cobb County (770) 792-3937
GEORGIA OPHTHALMOLOGY REFERRAL CENTER, LLC
Ophthalmology
1415 WOOTEN LAKE RD NW, SUITE 130
KENNESAW, GA 30144
Cobb County (866) 527-3722
JONATHAN WOOLFSON MD, PC
Ophthalmology
1415 WOOTEN LAKE RD NW, SUITE 100
KENNESAW, GA 30144
Cobb County (770) 424-8101
MR. CHRIS HOBSON O.D.
Optometrist
1415 WOOTEN LAKE RD NW, SUITE 100
KENNESAW, GA 30144
Cobb County (770) 424-2020
H & T EYE GROUP, LLC
Optometrist
1415 WOOTEN LAKE RD NW
KENNESAW, GA 30144
Cobb County (770) 424-8101
LAUREN ELIZABETH DANIEL OD
Optometrist
1415 WOOTEN LAKE RD NW
KENNESAW, GA 30144
Cobb County (770) 573-4345

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Russell Anderson's NPI number?

The NPI number for Russell Anderson is 1811068620. It was assigned to this individual provider in the NPPES registry on November 13, 2006.

Where is Russell Anderson located?

Russell Anderson practices at 1415 Wooten Lake Rd NW Suite 300, Kennesaw, GA 30144. The listed phone number is (770) 419-2535.

What is Russell Anderson's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Russell Anderson enrolled in Medicare?

No. Russell Anderson has opted out of Medicare through September 6, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Russell Anderson was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.