Dr. John E Russo, DMD

Dentist, General Practice in Orlando, FL. Individual provider (NPI-1).

NPI number1679538367

StatusActive

Last updated in NPPESJan 14, 2024

Details

NPI: 1679538367
Entity type: Individual (NPI-1)
Name: Dr. John E Russo
Credential: DMD
Sex: Male
Sole proprietor: Yes
Enumeration date: Apr 18, 2006
Certification date: Jan 14, 2024
Last updated: Jan 14, 2024

Medicare and OIG

Medicare enrolled (PECOS): Not in the Medicare enrollment file
Can order and refer: Not on the CMS order and referring list
OIG exclusion list: This NPI is not listed

CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
1223G0001X	Dentist, General Practice	DN0013542	FL	Yes

Practice location

430 N Mills Ave
Orlando, FL 32803-5746

Phone 407-843-2112 · Fax 407-843-1702

Mailing address

430 N Mills Ave Ste 3
Orlando, FL 32803-5746

Phone 407-843-2112 · Fax 407-843-1702

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

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