Active NPI
Mia Francesca Russo, DMD
- Dentist
- Longmeadow, MA
National Provider Identifier
1497313159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DEN03464
- Practice address
- 110 Lawnwood Ave
Longmeadow, MA 01106-3021 - Phone
- (413) 335-2408
- NPI assigned
- May 29, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | DEN03464 | RI | Primary |
Addresses
Primary practice location
110 Lawnwood Ave
Longmeadow, MA 01106-3021
Mailing address
110 Lawnwood Ave
Longmeadow, MA 01106-3021
Phone (413) 335-2408
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DEN03464 | RI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605830400000",
"number": "1497313159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 LAWNWOOD AVE",
"city": "LONGMEADOW",
"state": "MA",
"postal_code": "011063021",
"telephone_number": "413-335-2408"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 LAWNWOOD AVE",
"city": "LONGMEADOW",
"state": "MA",
"postal_code": "011063021",
"telephone_number": "413-335-2408"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "MIA",
"middle_name": "FRANCESCA",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-29",
"last_updated": "2020-11-20",
"certification_date": "2020-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "RI",
"license": "DEN03464",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longmeadow, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.