Healthcare Provider Details

I. General information

NPI: 1013011352
Provider Name (Legal Business Name): HERTZLER & RUSSO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10493 FRANKSTOWN ROAD
PITTSBURGH PA
15235
US

IV. Provider business mailing address

10493 FRANKSTOWN ROAD
PITTSBURGH PA
15235
US

V. Phone/Fax

Practice location:
  • Phone: 412-371-2442
  • Fax: 412-371-3892
Mailing address:
  • Phone: 412-371-2442
  • Fax: 412-371-3892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS026260L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS019248L
License Number StatePA

VIII. Authorized Official

Name: DR. PHILLIP NICHOLAS RUSSO
Title or Position: OWNER SECRETARY
Credential: DDS
Phone: 412-371-2442