# JESSICA RUSSO REVAND, DMD, MS, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Russo Endodontics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669060364
- **Authorized official:** DR. JESSICA RUSSO REVAND DMD, MS (OWNER/ENDODONTIST)
- **Authorized official phone:** (703) 503-0555

## Contact information

- **Practice address:** 8987 HERSAND DR STE 3, BURKE, VA 22015-1604
- **Practice address phone:** (703) 503-0555
- **Mailing address:** 10603 OLIVER ST, FAIRFAX, VA 22030-3913
- **Mailing address phone:** (202) 270-4779

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | NULL | Yes |
| 1223E0200X | Endodontics | — | — | Yes |

## Other

- **Enumeration date:** 01/07/2021
- **Last updated:** 01/07/2021