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General NPI Number Information
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NPI Number | 1861682460
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Entity Type | Organization
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Legal Business Name | GUS S. RUSSO DDS PC
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 07/30/2007
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Provider Practice Location Address
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Address Line | 310 MIDDLETOWN BLVD THE COURTYARD AT OXFORD VALLEY STE 202
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City | LANGHORNE
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State | PA
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Zip | 19047-3203
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Country | US
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Telephone | 215-757-0864
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Fax | 215-757-8090
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Provider Business Mailing Address
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Address Line | 310 MIDDLETOWN BLVD THE COURTYARD AT OXFORD VALLEY STE 202
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City | LANGHORNE
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State | PA
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Zip | 19047-3203
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Country | US
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Telephone | 215-757-0864
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Fax | 215-757-8090
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. GUS S RUSSO
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Credential | DDS
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Telephone | 215-757-0864
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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 | DSO19052L
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License Number State | PA
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