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Individual

DR. NICHOLAS VITO RUSSO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
12690 W NORTH AVE, BROOKFIELD, WI 53005-4636
(262) 784-3740
Mailing address
12690 W NORTH AVE, BROOKFIELD, WI 53005-4636
(262) 784-3740

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1000994-15
WI

Other

Enumeration date
08/13/2014
Last updated
02/09/2016
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