Provider Demographics
NPI:1841415775
Name:CASTNER, RUSSELL L (DDS)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:L
Last Name:CASTNER
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 1:1147 N 185TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-4001
Mailing Address - Country:US
Mailing Address - Phone:206-542-7100
Mailing Address - Fax:206-546-8763
Practice Address - Street 1:1147 N 185TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4001
Practice Address - Country:US
Practice Address - Phone:206-542-7100
Practice Address - Fax:206-546-8763
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA46051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5393509OtherDSHS