Individual
DR. JUSTIN RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3811 ED DR STE 120, RALEIGH, NC 27612-2393
(919) 890-5147
(919) 890-5953
Mailing address
3811 ED DR STE 120, RALEIGH, NC 27612-2393
(919) 890-5147
(919) 890-5953
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9061
NC
1223G0001X
General Practice Dentistry
DS039342
PA
Other
Enumeration date
07/20/2010
Last updated
03/20/2019
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