Provider Demographics
NPI:1013011352
Name:HERTZLER & RUSSO PC
Entity Type:Organization
Organization Name:HERTZLER & RUSSO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:412-371-2442
Mailing Address - Street 1:10493 FRANKSTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235
Mailing Address - Country:US
Mailing Address - Phone:412-371-2442
Mailing Address - Fax:412-371-3892
Practice Address - Street 1:10493 FRANKSTOWN ROAD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235
Practice Address - Country:US
Practice Address - Phone:412-371-2442
Practice Address - Fax:412-371-3892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026260L122300000X
PADS019248L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty