Individual
DR. JONATHAN P RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
11110 FORT ST STE 106, OMAHA, NE 68164-2183
(402) 492-8300
Mailing address
406 MAYMONT DR, CRAMERTON, NC 28032-1611
(704) 840-6342
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8115
NE
Other
Enumeration date
04/25/2025
Last updated
07/30/2025
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