Individual
DR. RUSSELL D BLACKHURST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
913 SW HIGGINS AVE, 201, MISSOULA, MT 59803-1461
(406) 721-2686
(406) 721-1213
Mailing address
913 SW HIGGINS AVE, 201, MISSOULA, MT 59803-1461
(406) 721-2686
(406) 721-1213
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
9453
CO
1223G0001X
General Practice Dentistry
Primary
2306
MT
Other
Enumeration date
08/30/2007
Last updated
08/11/2011
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