Provider Demographics
NPI:1609364108
Name:D'AMORE RUSSO DENTAL DESIGN STUDIO DR DDS
Entity Type:Organization
Organization Name:D'AMORE RUSSO DENTAL DESIGN STUDIO DR DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CARLO
Authorized Official - Last Name:D'AMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-233-1161
Mailing Address - Street 1:100 GROVE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4006
Mailing Address - Country:US
Mailing Address - Phone:973-233-1161
Mailing Address - Fax:
Practice Address - Street 1:100 GROVE ST STE 3
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4006
Practice Address - Country:US
Practice Address - Phone:973-233-1161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty