Individual
MICHAEL RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
175 EAGLE ROCK AVE, ROSELAND, NJ 07068-1321
(973) 226-1973
Mailing address
175 EAGLE ROCK AVE, ROSELAND, NJ 07068-1321
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
22DI02639100
NJ
Other
Enumeration date
03/30/2015
Last updated
01/22/2019
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