Provider Demographics
NPI:1205842069
Name:BLEILER, RUSSEL III (DMD)
Entity type:Individual
Prefix:DR
First Name:RUSSEL
Middle Name:
Last Name:BLEILER
Suffix:III
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 1:360 MIDDLETOWN BLVD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1863
Mailing Address - Country:US
Mailing Address - Phone:215-752-4646
Mailing Address - Fax:215-752-4650
Practice Address - Street 1:360 MIDDLETOWN BLVD
Practice Address - Street 2:SUITE 406
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1863
Practice Address - Country:US
Practice Address - Phone:215-752-4646
Practice Address - Fax:215-752-4650
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028088L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA909146OtherHIGHMARK PROVIDER NUMBER
PA2653716OtherAETNA PROVIDER NUMBER
PA061352Medicare ID - Type UnspecifiedPROVIDER NUMBER MEDICARE