Active NPI
Russell Kiser II, D.D.S., M.S.
- Endodontics
- Mansfield, OH
National Provider Identifier
1093737322
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 21063
- Practice address
- 1245 S Trimble Rd
Mansfield, OH 44907-2229 - Phone
- (419) 756-2880
- Fax
- (419) 775-8820
- NPI assigned
- Jul 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 21063 | OH | Primary |
Addresses
Primary practice location
1245 S Trimble Rd
Mansfield, OH 44907-2229
Mailing address
1221 S Trimble Rd, BLDG a Suite A1
Mansfield, OH 44907-2229
Phone (419) 756-2880
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150409001046 | OH | Order and Referring Only - Dentist | 2163514407 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459382400000",
"number": "1093737322",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1221 S TRIMBLE RD, BLDG A SUITE A1",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449072229",
"telephone_number": "419-756-2880",
"fax_number": "419-775-8820"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1245 S TRIMBLE RD",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449072229",
"telephone_number": "419-756-2880",
"fax_number": "419-775-8820"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KISER",
"first_name": "RUSSELL",
"name_prefix": "Dr.",
"name_suffix": "II",
"credential": "D.D.S., M.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-24",
"last_updated": "2016-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "OH",
"license": "21063",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2016; 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.