Healthcare Provider Details

I. General information

NPI: 1467373308
Provider Name (Legal Business Name): WISCO RUSSO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ALBIZU CAMPOS (CARR 107) #2022 KM 1.2 BO MARBELLA
AGUADILLA PR
00603
US

IV. Provider business mailing address

PO BOX 2894
MAYAGUEZ PR
00681-2894
US

V. Phone/Fax

Practice location:
  • Phone: 787-643-5041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ALEJANDRO WISCOVITCH RUSSO
Title or Position: OWNER AND CHIEF DENTIST
Credential: DMD
Phone: 787-643-5041