Individual
DR. ANTONINO RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5225 NESCONSET HWY, SUITE 3, PORT JEFFERSON STATION, NY 11776-2053
(631) 473-6661
(631) 473-6967
Mailing address
5225 NESCONSET HWY, SUITE 3, PORT JEFFERSON STATION, NY 11776-2053
(631) 473-6661
(631) 473-6967
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
38381
NY
Other
Enumeration date
08/19/2006
Last updated
07/08/2007
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