Individual
DR. NICHOLAS ROY RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
6754 W BELOIT RD, WEST ALLIS, WI 53219-2068
(414) 327-1210
(414) 327-6850
Mailing address
6754 W BELOIT RD, WEST ALLIS, WI 53219-2068
(414) 327-1210
(414) 327-6850
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2838
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33440400
—
WI
Enumeration date
02/27/2007
Last updated
07/08/2007
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