Provider Demographics
NPI:1295846921
Name:RUSSO, CARMINE CARLO (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:CARMINE
Middle Name:CARLO
Last Name:RUSSO
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6 PROSPECT ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1606
Mailing Address - Country:US
Mailing Address - Phone:201-445-5555
Mailing Address - Fax:201-445-5057
Practice Address - Street 1:6 PROSPECT ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1606
Practice Address - Country:US
Practice Address - Phone:201-445-5555
Practice Address - Fax:201-445-5057
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0183751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics