Individual
MS. JENNA RUSSELL DALLINGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
40 LAKE AVENUE EXT, DANBURY, CT 06811-5283
(845) 612-9849
Mailing address
103 HARVEST DR, BREWSTER, NY 10509-3706
(845) 612-9849
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
005456
CT
Other
Enumeration date
03/27/2012
Last updated
03/27/2012
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