Provider Demographics
NPI:1427235944
Name:RUSSEL S. BLEILER, III DMD PC
Entity type:Organization
Organization Name:RUSSEL S. BLEILER, III DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLEILER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:215-752-4646
Mailing Address - Street 1:360 MIDDLETOWN BLVD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1863
Mailing Address - Country:US
Mailing Address - Phone:215-752-4646
Mailing Address - Fax:215-752-4650
Practice Address - Street 1:360 MIDDLETOWN BLVD
Practice Address - Street 2:SUITE 406
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1863
Practice Address - Country:US
Practice Address - Phone:215-752-4646
Practice Address - Fax:215-752-4650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA909146OtherHIGHMARK PROVIDER NUMBER
PA061352OtherMEDICARE PROVIDER NUMBER
PA0354846000OtherIBC PROVIDER NUMBER
PA2653716OtherAETNA PROVIDER NUMBER