Illuzzi-Russo, Angela Michelle

Illuzzi-Russo, Angela Michelle is an sole proprietor health care provider with primary practice located at 190 Park Ave , Portland ME 04102-1000. She recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as her primary health care specialty. Illuzzi-Russo, Angela Michelle can be contacted via phone (207) 874-1028.

Contact Information

Primary practice address
190 Park Ave Portland ME 04102-1000
Phone: (207) 874-1028
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 052809 New York
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 22DI02347100 New Jersey
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X DEN4836 Maine

Profile Details

NPI number 1811041726
LBN Legal business name Illuzzi-Russo, Angela Michelle
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 22nd, 2007
Last updated Feb 4th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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