Organization
JUSTIN RUSSO DDS PA
Active
Other names
Russo Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN RUSSO DDS (OWNER)
(919) 890-5147
Entity
Organization
Contact information
Practice address
3811 ED DR STE 120, RALEIGH, NC 27612
(919) 890-5147
Mailing address
3811 ED DR STE 120, RALEIGH, NC 27612-2393
(919) 890-5147
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
06/01/2018
Last updated
03/20/2019
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