Individual
RUSSELL LAROY CHRISTIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
522 SPRINGDALE ST STE 101, MOUNT HOREB, WI 53572-1780
(608) 437-5564
(608) 437-8790
Mailing address
522 SPRINGDALE ST, SUITE 101, MOUNT HOREB, WI 53572-1780
(608) 437-5564
(608) 437-8790
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4703-015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336149525
NPI
WI
Enumeration date
07/28/2005
Last updated
12/21/2022
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