Provider Demographics
NPI:1740458017
Name:RUSSELL, CANNUTTE N (DDS)
Entity type:Individual
Prefix:DR
First Name:CANNUTTE
Middle Name:N
Last Name:RUSSELL
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 SOUTH STATE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609
Mailing Address - Country:US
Mailing Address - Phone:773-536-4729
Mailing Address - Fax:773-536-2525
Practice Address - Street 1:5050 SOUTH STATE
Practice Address - Street 2:SUITE 213
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60440
Practice Address - Country:US
Practice Address - Phone:773-536-4729
Practice Address - Fax:773-536-2525
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice