Provider Demographics
NPI:1568662880
Name:RUSSO, AUGUSTUS S (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTUS
Middle Name:S
Last Name:RUSSO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:GUS
Other - Middle Name:S
Other - Last Name:RUSSO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:310 MIDDLETOWN BLVD
Mailing Address - Street 2:THE COURTYARD AT OXFORD VALLEY #202
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-3203
Mailing Address - Country:US
Mailing Address - Phone:215-757-0864
Mailing Address - Fax:215-757-8090
Practice Address - Street 1:310 MIDDLETOWN BLVD
Practice Address - Street 2:THE COURTYARD AT OXFORD VALLEY #202
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-3203
Practice Address - Country:US
Practice Address - Phone:215-757-0864
Practice Address - Fax:215-757-8090
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019052L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics