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Organization

RUSSOMANNO KEANE DDS PA

Active
Other names
Bluejay Family Dentistry
Organization subpart
No

Provider details

NPI number
Authorized official
SAM JACOBSON (BUSINESS MANAGER)
(651) 307-4966
Entity
Organization

Contact information

Practice address
1975 11TH AVE E, MAPLEWOOD, MN 55109-5148
(651) 770-2900
Mailing address
8910 PENN AVE S, BLOOMINGTON, MN 55431-2025
(952) 881-0504

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary

Other

Enumeration date
07/24/2020
Last updated
07/24/2020
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