Individual
RUSSELL THEODORE KITTLESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
10521 N PORT WASHINGTON RD # 13W, MEQUON, WI 53092-5584
(262) 241-3142
(262) 241-3634
Mailing address
10521 N PORT WASHINGTON RD # 13W, MEQUON, WI 53092-5584
(262) 241-3142
(262) 241-3634
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4001404
WI
Other
Enumeration date
06/22/2007
Last updated
07/08/2007
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