Individual provider · Type 1 NPI

Antonino Russo, DDS

Orthodontics and Dentofacial Orthopedics Dentistry · Port Jefferson Station, NY

NPI number 1497860837 Active

Practice location

5225 Nesconset Hwy, Suite 3
Port Jefferson Station, NY 11776-2053

Call (631) 473-6661 Map

Fax (631) 473-6967

Specialties and licenses

TaxonomyCodeLicense
Orthodontics and Dentofacial Orthopedics Dentistry Primary 1223X0400X38381 (NY)

Orthodontics and Dentofacial Orthopedics Dentistry: That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of funct…

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About NPI 1497860837

Antonino Russo, DDS's National Provider Identifier is 1497860837, issued on Aug 19, 2006. The primary taxonomy on file is Orthodontics and Dentofacial Orthopedics Dentistry (1223X0400X), and the practice location is in Port Jefferson Station, NY. The record was last updated on Jul 8, 2007.