Provider Demographics
NPI:1780885947
Name:RUSSON, JAMES (DDS MPH)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:RUSSON
Suffix:
Gender:M
Credentials:DDS MPH
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:E
Other - Last Name:RUSSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:817 N 250 W
Mailing Address - Street 2:DANBURY LANE
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6873
Mailing Address - Country:US
Mailing Address - Phone:801-294-5781
Mailing Address - Fax:
Practice Address - Street 1:817 N 250 W
Practice Address - Street 2:DANBURY LANE
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6873
Practice Address - Country:US
Practice Address - Phone:801-294-5781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT138216-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice