Individual
DR. MARY KATHLEEN RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D
Contact information
Practice address
804 HIGHWAY 71, SEA GIRT, NJ 08750-2807
(732) 449-6564
(732) 449-8606
Mailing address
808 SPRAY AVE, BEACHWOOD, NJ 08722-4626
(973) 747-5383
(732) 449-6564
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI02293800
NJ
Other
Enumeration date
01/19/2007
Last updated
07/10/2015
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