Organization
FOULK ROAD DENTAL
Active
Other names
park place dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN N RUSSO D.D.S. (OWNER)
(302) 652-3775
Entity
Organization
Contact information
Practice address
300 FOULK RD, SUITE 101, WILMINGTON, DE 19803-3886
(302) 652-3775
Mailing address
1100 LOVERING AVE, WILMINGTON, DE 19806-3273
(302) 652-7447
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
GI00001156
DE
1223G0001X
General Practice Dentistry
GI00001157
DE
1223G0001X
General Practice Dentistry
Primary
GI0000719
DE
1223G0001X
General Practice Dentistry
GI0001031
DE
Other
Enumeration date
01/22/2007
Last updated
08/22/2020
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