Provider Demographics
NPI:1902010895
Name:RUSS & SENDER DDS PC
Entity Type:Organization
Organization Name:RUSS & SENDER DDS PC
Other - Org Name:BROADWAY DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUSS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-681-2525
Mailing Address - Street 1:82 WEST JOHN STREET
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801
Mailing Address - Country:US
Mailing Address - Phone:516-681-2525
Mailing Address - Fax:516-681-3514
Practice Address - Street 1:82 WEST JOHN STREET
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801
Practice Address - Country:US
Practice Address - Phone:516-681-2525
Practice Address - Fax:516-681-3514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty