Organization
PETER A. RUSSO, DDS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER RUSSO DDS (OWNER)
(714) 842-2515
Entity
Organization
Contact information
Practice address
18800 MAIN ST, SUITE 201, HUNTINGTON BEACH, CA 92648-1707
(714) 842-2515
(714) 847-7075
Mailing address
18800 MAIN ST, SUITE 201, HUNTINGTON BEACH, CA 92648-1707
(714) 842-2515
(714) 847-7075
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
04/28/2017
Last updated
04/28/2017
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