# DR. RUSSELL D BLACKHURST

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1801080015
- **Gender:** Man
- **Credential:** D.M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 9453 | CO | — |
| 1223G0001X | General Practice Dentistry | 2306 | MT | Yes |

## Other

- **Enumeration date:** 08/30/2007
- **Last updated:** 08/11/2011