Organization Active NPI

Justin M Russo DDS PLLC

  • Dental Clinic/Center
  • Raleigh, NC
National Provider Identifier
1457844524
Registry record updated Mar 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
JUSTIN M RUSSO DDS PLLC
Practice address
13220 Strickland Rd Ste 166
Raleigh, NC 27613-5213
Phone
(919) 890-5147
NPI assigned
Jun 12, 2018
Last updated
Mar 20, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2019

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

Authorized official

Name
Justin Russo, DDSNPI 1205149275
Title
Owner
Phone
(919) 890-5147

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
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

13220 Strickland Rd Ste 166
Raleigh, NC 27613-5213

Mailing address

3811 Ed Dr Ste 120
Raleigh, NC 27612-2393
Phone (919) 890-5147

National Provider Directory

National Provider Directory

Locations

3811 Ed Dr
Ste 120
Raleigh, NC 27612
Phone (919) 890-5147

Practitioners & affiliated clinicians

Practitioners 1

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": "1528761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553040000000",
    "number": "1457844524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3811 ED DR STE 120",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276122393",
            "telephone_number": "919-890-5147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13220 STRICKLAND RD STE 166",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276135213",
            "telephone_number": "919-890-5147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUSTIN M RUSSO DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-12",
        "last_updated": "2019-03-20",
        "status": "A",
        "authorized_official_last_name": "RUSSO",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-890-5147",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2019; 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.