NPIMap

Organization Active NPI

Peter a. Russo, DDS, Inc.

  • Periodontics
  • Huntington Beach, CA
National Provider Identifier
1194250019
Registry record updated Apr 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
PETER A. RUSSO, DDS, INC.
Practice address
18800 Main St
Suite 201
Huntington Beach, CA 92648-1707
Phone
(714) 842-2515
Fax
(714) 847-7075
NPI assigned
Apr 28, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Peter Russo, DDSNPI 1104846849
Title
Owner
Phone
(714) 842-2515

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0300X Primary

Addresses

Primary practice location

18800 Main St
Suite 201
Huntington Beach, CA 92648-1707

Mailing address

18800 Main St
Suite 201
Huntington Beach, CA 92648-1707
Phone (714) 842-2515

National Provider Directory

National Provider Directory

Locations

18800 Main St
Ste 201
Huntington Beach, CA 92648
Phone (714) 842-2515

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1493337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493337600000",
    "number": "1194250019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18800 MAIN ST",
            "address_2": "SUITE 201",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926481707",
            "telephone_number": "714-842-2515",
            "fax_number": "714-847-7075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18800 MAIN ST",
            "address_2": "SUITE 201",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926481707",
            "telephone_number": "714-842-2515",
            "fax_number": "714-847-7075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER A. RUSSO, DDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-28",
        "last_updated": "2017-04-28",
        "status": "A",
        "authorized_official_last_name": "RUSSO",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-842-2515",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.