Russell Theodore Kittleson, DDS

NPI #1528264819 in Mequon, Wisconsin

Provider Information

NPI Number: 1528264819
Entity Type: Individual
Name: Russell Theodore Kittleson, DDS
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist
Credential: DDS
Enumeration Date: Jun 22, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 10521 N PORT WASHINGTON RD # 13W
City: Mequon
State: Wisconsin
ZIP Code: 53092-5584
Phone: (262) 241-3142

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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