Individual
DR. LAURA W RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
8726 W NORTH AVE, WAUWATOSA, WI 53226-2724
(414) 258-5351
Mailing address
1485 BARRINGTON WOODS DR, BROOKFIELD, WI 53045-2210
(262) 784-8963
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5875015
WI
Other
Enumeration date
09/06/2006
Last updated
07/08/2007
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