Provider Demographics
NPI:1508995093
Name:CRESSON, RUSSELL JEFFREY (DDS, MS)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:JEFFREY
Last Name:CRESSON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 KINGMAN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4236
Mailing Address - Country:US
Mailing Address - Phone:504-885-8863
Mailing Address - Fax:
Practice Address - Street 1:3333 KINGMAN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4236
Practice Address - Country:US
Practice Address - Phone:504-885-8863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA47751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics