Russo, Richard G.

Russo, Richard G. is an individual health care provider with primary practice located at 832 W Central Blvd , Orlando FL 32805-1809. He recently has only one registered license in Dental Providers / Dental Public Health, which is considered as his primary health care specialty. Russo, Richard G. can be contacted via phone (407) 836-2616.

Contact Information

Primary practice address
832 W Central Blvd Orlando FL 32805-1809
Phone: (407) 836-2616
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dental Public Health 1223D0001X DN10829 Florida

Profile Details

NPI number 1063553774
LBN Legal business name Russo, Richard G.
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 8th, 2007
Last updated Mar 7th, 2023 - about last year

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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063553774 NPPES
Florida MEDICAID 072262600
Florida Other DN10829

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