Individual
JENNY S. RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
115 WALNUT ST., ELLINGTON, MO 63638
(573) 663-3177
(573) 663-3188
Mailing address
PO BOX 579, ELLINGTON, MO 63638-0579
(573) 663-7529
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
—
—
Other
Enumeration date
10/04/2006
Last updated
07/08/2007
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