Provider Demographics
NPI:1447576749
Name:RUSSELL L. CASEMENT, DDS
Entity Type:Organization
Organization Name:RUSSELL L. CASEMENT, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CASEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-758-0866
Mailing Address - Street 1:1355 S COLORADO BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3316
Mailing Address - Country:US
Mailing Address - Phone:303-758-0866
Mailing Address - Fax:303-758-3657
Practice Address - Street 1:1355 S COLORADO BLVD STE 320
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3316
Practice Address - Country:US
Practice Address - Phone:303-758-0866
Practice Address - Fax:303-758-3657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36741223G0001X
CO86581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1679575740OtherINDIVIDUAL NPI
CO1083619035OtherINDIVIDUAL NPI
CO02036747Medicaid