NPIMap

Organization Active NPI

Charles D. Russo, DMD,PA

Doing business as Coral Springs Oral and Maxillofacial Surgery Associates

  • Oral and Maxillofacial Surgery (Dentist)
  • Coral Springs, FL
National Provider Identifier
1306035423
Registry record updated Apr 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
DN0008338 Issued in FL
Legal business name
CHARLES D. RUSSO, DMD,PA
Doing business as
Coral Springs Oral and Maxillofacial Surgery Associates
Practice address
2801 N University Dr
Suite 102
Coral Springs, FL 33065-5057
Phone
(954) 752-1045
Fax
(954) 344-9651
NPI assigned
Oct 16, 2007
Last updated
Apr 22, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2013

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

Authorized official

Name
Dr. Charles D Russo, DMDNPI 1295803443
Title
President
Phone
(954) 752-1045

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DN0008338 FL Primary

Addresses

Primary practice location

2801 N University Dr
Suite 102
Coral Springs, FL 33065-5057

Mailing address

2801 N University Dr
Suite 102
Coral Springs, FL 33065-5057
Phone (954) 752-1045

Other names 1

  • Coral Springs Oral and Maxillofacial Surgery Associates Doing business as

National Provider Directory

National Provider Directory

Locations

2801 N University Dr
Ste 102
Coral Springs, FL 33065
Phone (954) 752-1045

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1192492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366588800000",
    "number": "1306035423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 N UNIVERSITY DR",
            "address_2": "SUITE 102",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330655057",
            "telephone_number": "954-752-1045",
            "fax_number": "954-344-9651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 N UNIVERSITY DR",
            "address_2": "SUITE 102",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330655057",
            "telephone_number": "954-752-1045",
            "fax_number": "954-344-9651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES D. RUSSO, DMD,PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-16",
        "last_updated": "2013-04-22",
        "status": "A",
        "authorized_official_last_name": "RUSSO",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-752-1045",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN0008338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coral Springs Oral and Maxillofacial Surgery Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coral Springs, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2013; 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.