Provider Demographics
NPI:1205914637
Name:RUSSELL J DIPALMA DDS PC
Entity type:Organization
Organization Name:RUSSELL J DIPALMA DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DIPALMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-673-9136
Mailing Address - Street 1:195 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063
Mailing Address - Country:US
Mailing Address - Phone:716-673-9136
Mailing Address - Fax:716-679-2221
Practice Address - Street 1:195 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063
Practice Address - Country:US
Practice Address - Phone:716-673-9136
Practice Address - Fax:716-679-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033019122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty