Individual
DR. RICHARD G. RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
832 W CENTRAL BLVD, ORLANDO, FL 32805-1809
(407) 836-2616
Mailing address
2500 21ST ST NW APT 79, WINTER HAVEN, FL 33881-1275
(863) 299-7748
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
DN10829
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
072262600
—
FL
01
—
DN10829
STATE LICENSE
FL
Enumeration date
02/08/2007
Last updated
03/07/2023
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