Individual provider Active NPI

Russell K. Hanes, D.D.S.

  • General Practice Dentistry
  • Sierra Vista, AZ
National Provider Identifier
1336100569
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3507 Issued in AZ
Practice address
1900 Paseo San Luis
Sierra Vista, AZ 85635-4614
Phone
(520) 458-2415
NPI assigned
Mar 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 3507 AZ Primary

Addresses

Primary practice location

1900 Paseo San Luis
Sierra Vista, AZ 85635-4614

Mailing address

1900 Paseo San Luis
Sierra Vista, AZ 85635-4614
Phone (520) 458-2415

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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

Enrollment IDStateProvider typePAC IDDetails
I20150115000149 AZ Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 7416271721

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3507AZMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Russell K. Hanes DDS, PC Past Accepting new patients
Pueblo del Sol Dental Care LLC General Practice PastSince Jul 24, 2022 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1336100569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 PASEO SAN LUIS",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856354614",
            "telephone_number": "520-458-2415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 PASEO SAN LUIS",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856354614",
            "telephone_number": "520-458-2415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANES",
        "first_name": "RUSSELL",
        "middle_name": "K.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "3507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sierra Vista, AZ

Sources for this page

Verify at the official NPI Registry.