Individual
DR. LISA MARIE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
655 CLINIC RD, SUITE 110, HANNIBAL, MO 63401-3647
(573) 221-0001
Mailing address
655 CLINIC RD, SUITE 110, HANNIBAL, MO 63401-3647
(573) 221-0001
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2011028140
MO
Other
Enumeration date
03/05/2012
Last updated
03/05/2012
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