Individual
DR. JENNIFER ANN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S., M.S.D.
Contact information
Practice address
13752 LAKERIDGE DR, FISHERS, IN 46037-7608
(317) 576-9400
Mailing address
5115 N PENNSYLVANIA ST, INDIANAPOLIS, IN 46205-1038
(317) 726-0136
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
12010066A
IN
Other
Enumeration date
04/02/2007
Last updated
07/08/2007
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