Individual
DR. STEPHEN P RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
25 E. WASHINGTON ST, SUITE 1125, CHICAGO, IL 60602
(312) 641-2572
(312) 641-6621
Mailing address
25 E. WASHINGTON ST, SUITE 1125, CHICAGO, IL 60602
(312) 641-2572
(312) 641-6621
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
019-026457
IL
Other
Enumeration date
03/15/2007
Last updated
03/31/2014
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