Individual provider · Type 1 NPI

Samuel Yohannes Russom, DDS

Pediatric Dentistry · Chula Vista, CA

NPI number 1144719196 Active

Practice location

2015 Birch Rd Ste 103
Chula Vista, CA 91915-2003

Call (619) 391-9287 Map

Mailing address

5311 Oak Park Dr
San Diego, CA 92105-4959

Specialties and licenses

TaxonomyCodeLicense
Pediatric Dentistry Primary 1223P0221XDDS104651 (CA)

Pediatric Dentistry: An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

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About NPI 1144719196

Samuel Yohannes Russom, DDS's National Provider Identifier is 1144719196, issued on May 4, 2018. The primary taxonomy on file is Pediatric Dentistry (1223P0221X), and the practice location is in Chula Vista, CA. The record was last updated on Dec 28, 2021.