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General NPI Number Information
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NPI Number | 1326380296
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Entity Type | Individual
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Provider Name | RUSSELL V. FU DDS
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Gender | Male
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Dates
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Enumeration Date | 03/19/2013
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 7105 JANES AVE
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City | WOODRIDGE
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State | IL
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Zip | 60517-2321
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Country | US
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Telephone | 630-963-7766
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Fax | 630-963-7850
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Provider Business Mailing Address
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Address Line | 7105 JANES AVE
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City | WOODRIDGE
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State | IL
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Zip | 60517-2321
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Country | US
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Telephone | 630-963-7766
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Fax | 630-963-7850
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019015275
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License Number State | IL
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