Provider Demographics
NPI:1437311941
Name:REDFEARN, TRENT RUSSELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:RUSSELL
Last Name:REDFEARN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4185 E WILDCAT RESERVE PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-6801
Mailing Address - Country:US
Mailing Address - Phone:303-683-2300
Mailing Address - Fax:303-346-8014
Practice Address - Street 1:4185 E WILDCAT RESERVE PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-6801
Practice Address - Country:US
Practice Address - Phone:303-683-2300
Practice Address - Fax:303-346-8014
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO96841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice