Provider Demographics
NPI:1609098789
Name:TRAPNELL, RUSSELL (DMD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:
Last Name:TRAPNELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 WYOMING BLVD NE STE G
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2679
Mailing Address - Country:US
Mailing Address - Phone:505-296-0761
Mailing Address - Fax:505-296-7543
Practice Address - Street 1:2010 WYOMING BLVD NE STE G
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2679
Practice Address - Country:US
Practice Address - Phone:505-296-0761
Practice Address - Fax:505-296-7543
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD31901223X0400X
CO91831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09328874Medicaid