# DR. ANGELA MICHELLE ILLUZZI-RUSSO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1811041726
- **Gender:** F
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 052809 | NY | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 22DI02347100 | NJ | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DEN4836 | ME | Yes |

## Other

- **Enumeration date:** 01/22/2007
- **Last updated:** 02/04/2021