Russo, Nicholas Roy
Russo, Nicholas Roy is an sole proprietor health care provider with primary practice located at 6754 W Beloit Rd , West Allis WI 53219-2068. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Russo, Nicholas Roy can be contacted via phone (414) 327-1210.Contact Information
Primary practice address
6754 W Beloit Rd
West Allis WI 53219-2068
Phone: (414) 327-1210
Fax: (414) 327-6850
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 2838 | Wisconsin |
Profile Details
| NPI number | 1134255672 |
|---|---|
| LBN Legal business name | Russo, Nicholas Roy |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 27th, 2007 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1134255672 | NPPES |
| Wisconsin | MEDICAID | 33440400 |
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