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General NPI Number Information
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NPI Number | 1285913723
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Entity Type | Individual
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Provider Name | STEPHEN RUSO D.D.S., M.S.
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Gender | Male
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Dates
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Enumeration Date | 08/15/2011
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Last Update Date | 11/22/2012
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Provider Practice Location Address
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Address Line | 1912 W REYNOLDS ST
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City | PLANT CITY
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State | FL
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Zip | 33563-4700
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Country | US
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Telephone | 813-567-7001
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Fax |
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Provider Business Mailing Address
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Address Line | 3412 WESTFIELD DR
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City | BRANDON
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State | FL
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Zip | 33511-7736
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN 19633
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License Number State | FL
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