Individual
DR. ANDREA W. RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
8014 CUMMING HWY, SUITE 401, CANTON, GA 30115-9339
(770) 345-2010
(770) 345-0571
Mailing address
8014 CUMMING HWY, SUITE 401, CANTON, GA 30115-9339
(770) 345-2010
(770) 345-0571
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN012175
GA
Other
Enumeration date
10/17/2006
Last updated
09/04/2007
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