Provider Demographics
NPI:1497834469
Name:RUSSO, RONALD CHARLES (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:CHARLES
Last Name:RUSSO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 E. MCDONALD DR.
Mailing Address - Street 2:SUITE 101-B
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-6000
Mailing Address - Country:US
Mailing Address - Phone:480-998-3355
Mailing Address - Fax:480-948-5153
Practice Address - Street 1:7500 E MCDONALD DR
Practice Address - Street 2:SUITE 101-B
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-6052
Practice Address - Country:US
Practice Address - Phone:480-998-3355
Practice Address - Fax:480-948-5153
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice