| NPI | 1861682460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GUS S RUSSO President/Owner 215-757-0864 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DSO19052L) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2007-07-30 |