Individual
MRS. ALISA L RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
2080 CHILD ST, BLDG 964 DENTAL, JACKSONVILLE, FL 32214-5005
(904) 546-7175
Mailing address
2080 CHILD ST, P.O. BOX 8 BLDG 964, JACKSONVILLE, FL 32214-5005
(904) 546-7175
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH 23693
FL
Other
Enumeration date
05/03/2017
Last updated
05/03/2017
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