Russell a Fortune DDS SC

Primary specialty

DentistTaxonomy code 122300000X

License

2778 Issued in WI

Legal business name

RUSSELL A FORTUNE DDS SC

Practice address

1600 Losey Blvd South
La Crosse, WI 54601-6104

Phone

(608) 782-8834

Fax

(608) 782-5223

NPI assigned

Sep 2, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Russell Alan Fortune, DDS

Title

President Owner

Phone

(608) 782-8834

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982706743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 LOSEY BLVD SOUTH",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546016104",
            "telephone_number": "608-782-8834",
            "fax_number": "608-782-5223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 LOSEY BLVD SOUTH",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546016104",
            "telephone_number": "608-782-8834",
            "fax_number": "608-782-5223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELL A FORTUNE DDS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FORTUNE",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "PRESIDENT  OWNER",
        "authorized_official_telephone_number": "608-782-8834",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WI",
            "license": "2778",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33429900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wendi S Ruoff, OTR
• Loucresie Nichelle Rupert, M.D.
• Stuart Jay Rupp, DMD
• Michael Steven Rusak
• Brenda Rush, RN
• Carol B Rust, RD
• Kay M Rutherford, PH.D., LPC
• Mandy M Rutta, AUD
• Catherine R Ryan, MD
• Danielle Ryan, RN

• Dentist in La Crosse, WI
• Providers in La Crosse, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.