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Individual

MICHAEL RUSSO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
2 CIRCLE AVE, WEST CHESTER, PA 19382-4808
(610) 696-1025
Mailing address
2 CIRCLE AVE, WEST CHESTER, PA 19382-4808

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS024419-L
PA

Other

Enumeration date
05/08/2015
Last updated
05/08/2015
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