Dr. Richard G. Russo
Dental Public Health
832 W Central Blvd
Orlando
, Florida 32805-1809
Dr. Richard G. Russo
Dental Public Health
832 W Central Blvd
Orlando
, Florida 32805-1809
(863) 299-7748
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About
Features
Specialties
- Dental Public Health
Languages spoken
- English
Location
First Address
- Dr. Richard G. Russo
- 2500 21st St Nw Apt 79
- Winter Haven, FL
- Zip : 33881-1275
- Phone : (863) 299-7748
Second Address
- Dr. Richard G. Russo
- 832 W Central Blvd
- Orlando, FL
- Zip : 32805-1809
- Phone : (407) 836-2616
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223D0001X | Dental Public Health | DN10829 | FL |
National Provider Identifier
| NPI | 1063553774 |
|---|---|
| Provider Name | Dr. Richard G. Russo |
| First Address | Winter Haven, FL 33881-1275 |
| Second Address | Orlando, FL 32805-1809 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 08/02/2007 |
| Last Update Date | 22/06/2011 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 072262600 | (05) | FL |
| BR0393164 | DEA NUMBER (01) | |
| DN10829 | STATE LICENSE (01) | FL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.