| NPI | 1013011352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP NICHOLAS RUSSO Owner Secretary 412-371-2442 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS026260L) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS019248L) |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2020-08-22 |