Individual
DR. EDWARD NICHOLAS RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2171 JERICHO TURNPIKE, SUITE # 145, COMMACK, NY 11725
(631) 462-6888
(631) 499-0775
Mailing address
2171 JERICHO TURNPIKE, SUITE # 145, COMMACK, NY 11725
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
040596
NY
Other
Enumeration date
02/01/2007
Last updated
07/08/2007
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