Provider Demographics
NPI:1386856391
Name:RUSSO, MICHELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELA
Middle Name:
Last Name:RUSSO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 PARSIPPANY ROAD
Mailing Address - Street 2:SUITE A4
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054
Mailing Address - Country:US
Mailing Address - Phone:973-428-1515
Mailing Address - Fax:973-428-7389
Practice Address - Street 1:362 PARSIPPANY ROAD
Practice Address - Street 2:SUITE A4
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054
Practice Address - Country:US
Practice Address - Phone:973-428-1515
Practice Address - Fax:973-428-7389
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI197751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice