Stephen P Russo is a Periodontics in Chicago, Illinois. Stephen P Russo practices all healthcare services and medical treatments related to Periodontics. The NPI Number for Stephen P Russo is 1699809202. The last update date is 2014-03-31.
Stephen P Russo's current location address is 25 E. Washington St, Chicago, Illinois. You can contact this provider via phone number 3126412572 and fax number 3126416621. The mailing address for Stephen P Russo is 25 E. Washington St, Chicago, Illinois. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Stephen P Russo |
|---|---|
| Address | 25 E. Washington St, Chicago, Illinois |
| Phone Number | 3126412572 |
| Fax Number | 3126416621 |
| Sole Proprietor | N |
| Credentials | DMD |
NPI Number Detail
| NPI Number | 1699809202 |
|---|---|
| Provider Enumeration Date | 2007-03-15 |
| Last Updated Date | 2014-03-31 |
Provider Mailing Address Detail
| Address | 25 E. Washington St |
|---|---|
| City | Chicago |
| State | Illinois (IL) |
| Post Code | 60602 |
| Phone Number | 3126412572 |
| Fax Number | 3126416621 |
Provider's Primary Taxonomy Detail
| Speciality | Periodontics |
|---|---|
| Taxonomy | 1223P0300X |
| Licence No | 019-026457 |
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Definition: That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structure |
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What is the unique 10-digit identification code issued to Stephen P Russo by the Centers for Medicare & Medicaid Services?
The Stephen P Russo has been assigned the NPI (National Provider Identifier) 1699809202 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for healthcare providers.
Could you share the physical location details of Stephen P Russo?
The Stephen P Russo is situated at 25 E. Washington St, in the city of Chicago, state of IL, with the zip code 60602.
What is Stephen P Russo's specialized area of practice, and what is the corresponding taxonomy classification code for this field?
The Stephen P Russo's specialized field of practice is Periodontics, and the corresponding taxonomy code that categorizes this area of specialization is 1223P0300X.
On what date did the Centers for Medicare & Medicaid Services originally issue the 1699809202 to Stephen P Russo?
The Centers for Medicare & Medicaid Services originally issued the 1699809202 to Stephen P Russo on 2007-03-15.
As of what date were the Stephen P Russo's details last updated?
The information pertaining to the Stephen P Russo, including its address, specialty, and other details, was most recently updated on 2014-03-31.
NPI Number: 1972505162
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