| Russell A Fortune Dds Sc | |
|
1600 Losey Blvd South La Crosse WI 54601-6104 | |
| (608) 782-8834 | |
| (608) 782-5223 |
| Full Name | Russell A Fortune Dds Sc |
|---|---|
| Speciality | Dentist |
| Location | 1600 Losey Blvd South, La Crosse, Wisconsin |
| Authorized Official Name and Position | Russell Alan Fortune (PRESIDENT OWNER) |
| Authorized Official Contact | 6087828834 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Russell A Fortune Dds Sc 1600 Losey Blvd South La Crosse WI 54601-6104 Ph: (608) 782-8834 | Russell A Fortune Dds Sc 1600 Losey Blvd South La Crosse WI 54601-6104 Ph: (608) 782-8834 |
| NPI Number | 1982706743 |
|---|---|
| Provider Enumeration Date | 09/02/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982706743 | NPI | - | NPPES |
| 33429900 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2778 (Wisconsin) | Primary |
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