Individual
JENNIFER ANN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2851 UNIVERSITY AVE, GREEN BAY, WI 54311
(920) 431-2500
Mailing address
2851 UNIVERSITY AVE, GREEN BAY, WI 54311-5855
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1001792
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/27/2017
Last updated
02/26/2025
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