# RUSSELL K. HANES DDS, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730393174
- **Authorized official:** DR. RUSSELL K HANES DDS (PRESIDENT)
- **Authorized official phone:** (520) 458-2415

## Contact information

- **Practice address:** 1900 PASEO SAN LUIS, SIERRA VISTA, AZ 85635-4614
- **Practice address phone:** (520) 458-2415
- **Mailing address:** 1900 PASEO SAN LUIS, SIERRA VISTA, AZ 85635-4614

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 3507 | AZ | Yes |

## Other

- **Enumeration date:** 05/09/2007
- **Last updated:** 08/22/2020