Provider Demographics
NPI:1144314279
Name:RUSSOW, LINDA KULMA (DDS)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:KULMA
Last Name:RUSSOW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 WETSTONE PL
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-7144
Mailing Address - Country:US
Mailing Address - Phone:407-529-4973
Mailing Address - Fax:407-889-2035
Practice Address - Street 1:2216 E SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5733
Practice Address - Country:US
Practice Address - Phone:407-529-4973
Practice Address - Fax:407-889-2037
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN83321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL077015900Medicaid