Provider Demographics
NPI:1487610812
Name:RUSSELL, SHARON S (DDS)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:S
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 E 1ST AVE
Mailing Address - Street 2:SUITE 580
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5810
Mailing Address - Country:US
Mailing Address - Phone:303-320-1640
Mailing Address - Fax:303-333-9148
Practice Address - Street 1:3300 E 1ST AVE
Practice Address - Street 2:SUITE 580
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5810
Practice Address - Country:US
Practice Address - Phone:303-320-1640
Practice Address - Fax:303-333-9148
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1059951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice