Provider Demographics
NPI:1962488858
Name:FORD, RUSSELL H (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:H
Last Name:FORD
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Gender:M
Credentials:DMD, MS
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Mailing Address - Street 1:9475 BRIAR VILLAGE PT
Mailing Address - Street 2:SUITE 315
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7901
Mailing Address - Country:US
Mailing Address - Phone:719-481-9199
Mailing Address - Fax:719-481-3376
Practice Address - Street 1:9475 BRIAR VILLAGE PT
Practice Address - Street 2:SUITE 315
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7901
Practice Address - Country:US
Practice Address - Phone:719-481-9199
Practice Address - Fax:719-481-3376
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO86181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics