Randall J Russell, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DEN.00201913 Issued in CO

Practice address

20971 E Smoky Hill Rd
Suite 201
Centennial, CO 80015-5186

Phone

(720) 870-1451

Fax

(720) 870-1456

NPI assigned

Jul 9, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Trauma and Emergency Subspecialty Surgeons PLLC

  • Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
  • Highlands Ranch, CO
  • NPI 1740543933
  Medicare reassignment
• Randall J Russell DDS PC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Centennial, CO
  • NPI 1811238264
  NPD (past) Authorized official
• Carlton J Floyd DDS Ms PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Centennial, CO
  • NPI 1871881664
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362960000000",
    "number": "1013170968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20971 E SMOKY HILL RD",
            "address_2": "SUITE 201",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "800155186",
            "telephone_number": "720-870-1451",
            "fax_number": "720-870-1456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20971 E SMOKY HILL RD",
            "address_2": "SUITE 201",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "800155186",
            "telephone_number": "720-870-1451",
            "fax_number": "720-870-1456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "RANDALL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-09",
        "last_updated": "2013-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CO",
            "license": "DEN.00201913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rule 1G, Inc LLC
• Kristian Rullan
• Robin Anthony Ruscio, MA, LPC, LIMHP
• Rush Dental Group, PLLC
• Krystalin Nicole Rush, PHARMD
• Rustic Rose Assisted Living
• Ana Lucia Ruzo, DDS
• Mary C Ryan
• Sean Ryan
• Steven Elliott Ryan, M.D.

• Oral and Maxillofacial Surgery (Dentist) in Centennial, CO
• Providers in Centennial, CO by specialty
• Oral and Maxillofacial Surgery (Dentist) in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.