Individual provider · NPI-1

Dr. Russell D Blackhurst, D.M.D.

Dentist, General Practice · Missoula, MT

NPI number1801080015
StatusActive
Last updated in NPPESAug 11, 2011

Details

NPI
1801080015
Entity type
Individual (NPI-1)
Name
Dr. Russell D Blackhurst
Credential
D.M.D.
Sex
Male
Sole proprietor
No
Enumeration date
Aug 30, 2007
Last updated
Aug 11, 2011

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice2306MTYes
122300000X Dentist9453CO

Practice location

913 Sw Higgins Ave
201
Missoula, MT 59803-1461

Phone 406-721-2686 · Fax 406-721-1213

Mailing address

913 Sw Higgins Ave
201
Missoula, MT 59803-1461

Phone 406-721-2686 · Fax 406-721-1213

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