Individual
DR. JOHN THOMAS RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
150 BROOKLINE AVE UNIT 606, BOSTON, MA 02215-3932
(941) 928-7887
Mailing address
150 BROOKLINE AVE UNIT 606, BOSTON, MA 02215-3932
(941) 928-7887
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN10000890
MA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/30/2025
Last updated
07/29/2025
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