Peter Anthony Russo
Periodontist
18800 Main St Ste. 201
Huntington Beach
, California 92648-1707
Peter Anthony Russo
Periodontist
18800 Main St Ste. 201
Huntington Beach
, California 92648-1707
(714) 847-7075
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About
Features
Specialties
- Periodontist
Languages spoken
- English
Location
First Address
- Peter Anthony Russo
- 18800 Main St Ste. 201
- Huntington Beach, CA
- Zip : 92648-1707
- Fax : (714) 847-7075
- Phone : (714) 842-2515
Second Address
- Peter Anthony Russo
- 18800 Main St Ste. 201
- Huntington Beach, CA
- Zip : 92648-1707
- Fax : (714) 847-7075
- Phone : (714) 842-2515
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223P0300X | Periodontist | 41127 | CA |
National Provider Identifier
| NPI | 1104846849 |
|---|---|
| Provider Name | Peter Anthony Russo |
| First Address | Huntington Beach, CA 92648-1707 |
| Second Address | Huntington Beach, CA 92648-1707 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 19/07/2006 |
| Last Update Date | 08/07/2007 |
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.