Individual
PETER ANTHONY RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
18800 MAIN ST, STE. 201, HUNTINGTON BEACH, CA 92648-1707
(714) 842-2515
(714) 847-7075
Mailing address
18800 MAIN ST, STE. 201, HUNTINGTON BEACH, CA 92648-1707
(714) 842-2515
(714) 847-7075
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
41127
CA
Other
Enumeration date
07/19/2006
Last updated
07/08/2007
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