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General NPI Number Information
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NPI Number | 1497834469
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Entity Type | Individual
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Provider Name | RONALD CHARLES RUSSO D.M.D
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Gender | Male
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 07/29/2016
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Provider Practice Location Address
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Address Line | 7500 E MCDONALD DR SUITE 101-B
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City | SCOTTSDALE
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State | AZ
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Zip | 85250-6052
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Country | US
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Telephone | 480-998-3355
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Fax | 480-948-5153
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Provider Business Mailing Address
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Address Line | 7500 E. MCDONALD DR. SUITE 101-B
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City | SCOTTSDALE
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State | AZ
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Zip | 85250-6000
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Country | US
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Telephone | 480-998-3355
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Fax | 480-948-5153
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2348
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License Number State | AZ
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