Individual
DR. STEFANIE LUISE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS, MPH, PHD
Contact information
Practice address
550 1ST AVE, SUITE QQ, NEW YORK, NY 10016-6402
(212) 263-7552
Mailing address
530 1ST AVE, SUITE QQ, NEW YORK, NY 10016-6402
(212) 263-7552
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
044169
NY
1223P0300X
Periodontics
22DI01818700
NJ
Other
Enumeration date
10/07/2010
Last updated
04/27/2017
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