Individual
GREGORY RUSSO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
351 MERLINE RD, SUITE 301, VERNON, CT 06066-4040
(860) 875-5664
(860) 875-0520
Mailing address
351 MERLINE RD, SUITE 301, VERNON, CT 06066-4040
(860) 875-5664
(860) 875-0520
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8923
CT
Other
Enumeration date
04/25/2007
Last updated
07/08/2007
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