Individual
DR. JESSICA RUSSO REVAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD, MS
Contact information
Practice address
4660 KENMORE AVE, SUITE 700, ALEXANDRIA, VA 22304-1313
(703) 370-1327
(703) 370-1907
Mailing address
4660 KENMORE AVE, SUITE 700, ALEXANDRIA, VA 22304-1313
(703) 370-1327
(703) 370-1907
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
0401412509
VA
1223E0200X
Endodontics
51517
CA
1223E0200X
Endodontics
DEN1000827
DC
Other
Enumeration date
07/13/2009
Last updated
07/13/2009
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