Individual
DR. JACQUELINE RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
11676 DUNES RD, BOYNTON BEACH, FL 33436-5503
(561) 212-9405
Mailing address
11676 DUNES RD, BOYNTON BEACH, FL 33436-5503
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN12954
FL
Other
Enumeration date
06/26/2017
Last updated
06/26/2017
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