Individual
DR. SAMUEL YOHANNES RUSSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2015 BIRCH RD STE 103, CHULA VISTA, CA 91915-2003
(619) 391-9287
Mailing address
5311 OAK PARK DR, SAN DIEGO, CA 92105-4959
(619) 263-0384
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DDS104651
CA
Other
Enumeration date
05/04/2018
Last updated
12/28/2021
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