Organization
THOMAS D. RUSSO, D.M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS D RUSSO D.M.D. (PRESIDENT)
(781) 721-4700
Entity
Organization
Contact information
Practice address
63 SHORE RD STE 13, WINCHESTER, MA 01890-2828
(781) 721-4700
(781) 729-0798
Mailing address
63 SHORE RD STE 13, WINCHESTER, MA 01890-2828
(781) 721-4700
(781) 729-0798
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
15641
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0263001
—
MA
01
—
661706
UNITED CONCORDIA
MA
01
—
RU10679
BLUE CROSS / BLUE SHIELD
MA
Enumeration date
02/09/2009
Last updated
06/21/2018
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