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General NPI Number Information
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NPI Number | 1013170968
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Entity Type | Individual
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Provider Name | RANDALL J RUSSELL D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2008
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Last Update Date | 03/11/2013
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Provider Practice Location Address
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Address Line | 20971 E SMOKY HILL RD SUITE 201
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City | CENTENNIAL
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State | CO
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Zip | 80015-5186
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Country | US
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Telephone | 720-870-1451
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Fax | 720-870-1456
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Provider Business Mailing Address
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Address Line | 20971 E SMOKY HILL RD SUITE 201
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City | CENTENNIAL
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State | CO
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Zip | 80015-5186
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Country | US
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Telephone | 720-870-1451
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Fax | 720-870-1456
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DEN.00201913
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License Number State | CO
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