Active NPI
Edward Russo Jr., DDS
- Dentist
- Scottsville, VA
National Provider Identifier
1639197122
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401005184
- Practice address
- 5665 Fieldcrest Dr
Scottsville, VA 24590-3886 - Phone
- (434) 286-3082
- Fax
- (434) 286-3082
- NPI assigned
- Jul 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401005184 | VA | Primary |
Addresses
Primary practice location
5665 Fieldcrest Dr
Scottsville, VA 24590-3886
Mailing address
5665 Fieldcrest Dr
Ic
Scottsville, VA 24590-3886
Phone (434) 286-3082
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008451192 | Medicaid | VA |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486512000000",
"number": "1639197122",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5665 FIELDCREST DR",
"address_2": "IC",
"city": "SCOTTSVILLE",
"state": "VA",
"postal_code": "245903886",
"telephone_number": "434-286-3082"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5665 FIELDCREST DR",
"city": "SCOTTSVILLE",
"state": "VA",
"postal_code": "245903886",
"telephone_number": "434-286-3082",
"fax_number": "434-286-3082"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "EDWARD",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2017-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401005184",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008451192",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Scottsville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 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.