Provider Demographics
NPI:1730336363
Name:RUSSELL, CORTNI MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:CORTNI
Middle Name:MARIE
Last Name:RUSSELL
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 1:2834 BROOKS CT
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-3671
Mailing Address - Country:US
Mailing Address - Phone:440-289-4790
Mailing Address - Fax:
Practice Address - Street 1:854 E AURORA RD
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-1904
Practice Address - Country:US
Practice Address - Phone:330-908-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30022782122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist