Organization
PERIODONTICS LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN P RUSSO DMD (PARTNER)
(847) 675-7555
Entity
Organization
Contact information
Practice address
4711 GOLF RD STE 101, SKOKIE, IL 60076-1239
(847) 675-7555
(847) 675-3734
Mailing address
4711 GOLF RD STE 101, SKOKIE, IL 60076-1239
(847) 675-7555
(847) 675-3734
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
IL
Other
Enumeration date
03/16/2007
Last updated
08/22/2020
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