Healthcare Provider Details

I. General information

NPI: 1720583222
Provider Name (Legal Business Name): ALEJANDRO JAVIER WISCOVITCH RUSSO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
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: 787-643-5041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3401
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: