Wynn Christopher Russo, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4223 Issued in LA

Practice address

2301 Williams Blvd
Kenner, LA 70062-5721

Phone

(504) 887-7811

Fax

(504) 469-5181

NPI assigned

Apr 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1881656403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 WILLIAMS BLVD",
            "city": "KENNER",
            "state": "LA",
            "postal_code": "700625721",
            "telephone_number": "504-887-7811",
            "fax_number": "504-469-5181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 WILLIAMS BLVD",
            "city": "KENNER",
            "state": "LA",
            "postal_code": "700625721",
            "telephone_number": "504-887-7811",
            "fax_number": "504-469-5181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "WYNN",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "4223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1842231",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "A-2040",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Thomas Rodriguez, PHARM. D.
• James D Roethele, DDS
• Nicole M Ross, CNA
• Kevin Rostetter
• Angela Ruiz, LCSW
• Saeed Ahmed LLC
• Roy Arturo Salgado Jr., PH.D., LPC, LMFT
• Maria J Salmeron, LCSW
• Samer Salti, DDS
• Sam'S Club Optical

• General Practice Dentistry in Kenner, LA
• Providers in Kenner, LA by specialty
• General Practice Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.