Provider Demographics
NPI:1518013440
Name:RUSSO-MOUNGER, AIMEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:
Last Name:RUSSO-MOUNGER
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 1:10235 JEFFERSON HWY.
Mailing Address - Street 2:BUILDING #5
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809
Mailing Address - Country:US
Mailing Address - Phone:225-292-7645
Mailing Address - Fax:225-292-0345
Practice Address - Street 1:10235 JEFFERSON HWY.
Practice Address - Street 2:BUILDING #5
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809
Practice Address - Country:US
Practice Address - Phone:225-292-7645
Practice Address - Fax:225-292-0345
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA51361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice