1902082464 NPI number — RONALD C. RUSSO D.M.D., P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902082464 NPI number — RONALD C. RUSSO D.M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RONALD C. RUSSO D.M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902082464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7500 E MCDONALD DR
Provider Second Line Business Mailing Address:
STE 101-B
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85250-6052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-998-3355
Provider Business Mailing Address Fax Number:
480-948-5153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7500 E MCDONALD DR
Provider Second Line Business Practice Location Address:
STE 101-B
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85250-6052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-998-3355
Provider Business Practice Location Address Fax Number:
480-948-5153
Provider Enumeration Date:
01/15/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RUSSO
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
480-998-3355

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X , with the licence number:  2348 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)