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General NPI Number Information
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NPI Number | 1407690506
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Entity Type | Individual
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Provider Name | JOSEPHINE RUSS DMD
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Gender | Female
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Dates
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Enumeration Date | 06/24/2024
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 1307 WHITE HORSE RD UNIT 500
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City | VOORHEES
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State | NJ
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Zip | 08043-2176
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Country | US
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Telephone | 856-628-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 5501 OLD YORK RD STE 1
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City | PHILADELPHIA
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State | PA
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Zip | 19141-3098
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DS045205
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI03104600
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License Number State | NJ
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