Provider Demographics
NPI:1841344124
Name:MARCHESE, RUSSELL MICHAEL JR (DDS)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:MICHAEL
Last Name:MARCHESE
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-2401
Mailing Address - Country:US
Mailing Address - Phone:585-343-2711
Mailing Address - Fax:
Practice Address - Street 1:401 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2401
Practice Address - Country:US
Practice Address - Phone:585-343-2711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0415641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice