DR. Nicholas Vito Russo, D.D.S.

NPI #1063811297 in Brookfield, Wisconsin

Provider Information

NPI Number: 1063811297
Entity Type: Individual
Name: DR. Nicholas Vito Russo, D.D.S.
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist
Credential: D.D.S.
Enumeration Date: Aug 13, 2014
Last Updated: Feb 9, 2016

Practice Location

Address: 12690 W NORTH AVE
City: Brookfield
State: Wisconsin
ZIP Code: 53005-4636
Phone: (262) 784-3740

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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