Provider Demographics
NPI:1518981018
Name:RUSSELL V. FU, DDS
Entity Type:Organization
Organization Name:RUSSELL V. FU, DDS
Other - Org Name:DR. RUSSELL FU
Other - Org Type:Other Name
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:V
Authorized Official - Last Name:FU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-963-7766
Mailing Address - Street 1:7105 JANES AVE
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2321
Mailing Address - Country:US
Mailing Address - Phone:630-963-7766
Mailing Address - Fax:630-963-7850
Practice Address - Street 1:7105 JANES AVE
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2321
Practice Address - Country:US
Practice Address - Phone:630-963-7766
Practice Address - Fax:630-963-7850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0600027441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty