Individual
MRS. JESSICA SUE LUSSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1501 W STOUT ST, RICE LAKE, WI 54868-5001
(714) 236-8900
Mailing address
2481 12 3/4 AVE, CAMERON, WI 54822-8725
(715) 205-7488
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
1002730-16
WI
Other
Enumeration date
09/03/2019
Last updated
09/03/2019
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