Provider Demographics
NPI:1174780415
Name:RIMA, RUSSELL (RUSSELL RIMA DDS)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:
Last Name:RIMA
Suffix:
Gender:M
Credentials:RUSSELL RIMA DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 HIWAY 95
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-6752
Mailing Address - Country:US
Mailing Address - Phone:928-758-2778
Mailing Address - Fax:928-758-7595
Practice Address - Street 1:1980 HIWAY 95
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-6752
Practice Address - Country:US
Practice Address - Phone:928-758-2778
Practice Address - Fax:928-758-7595
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD33391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice