Individual
DOMINIC JACOB DIRUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1450 LONG PRAIRIE RD, STE 160, FLOWER MOUND, TX 75028
(469) 293-2220
Mailing address
1801 CREST VIEW DR, CARROLLTON, TX 75006-1609
(972) 567-4830
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
38883
TX
Other
Enumeration date
12/30/2022
Last updated
12/30/2022
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