Individual
DR. JOHN RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
535 SAYBROOK RD, MIDDLETOWN, CT 06457-4743
(860) 347-7497
(860) 344-0522
Mailing address
836 FARMINGTON AVE, SUITE 115, WEST HARTFORD, CT 06119-1505
(860) 232-0033
(860) 232-1132
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
4961
CT
Other
Enumeration date
07/25/2006
Last updated
07/08/2007
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