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Organization
RUSSOMANNO KEANE DDS PA
Active
Organization
RUSSOMANNO KEANE DDS PA
Active
Other names
Bluejay Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
SAM JACOBSON (BUSINESS MANAGER)
(651) 307-4966
Entity
Organization
Contact information
Practice address
1975 11TH AVE E, MAPLEWOOD, MN 55109-5148
(651) 770-2900
Mailing address
8910 PENN AVE S, BLOOMINGTON, MN 55431-2025
(952) 881-0504
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/24/2020
Last updated
07/24/2020
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