IndividualActive
Angela Illuzzi-Russo, DDS
NPI 1811041726 · Oral and Maxillofacial Surgery (Dentist) · Portland, ME
Provider details
- NPI number
- 1811041726
- Entity type
- Individual
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)Dental Providers
- Credential
- DDS
- Sex
- Female
- Sole proprietor
- Yes
- License
- 052809 (NY)
Specialties & taxonomies
Dental Providers
Dental Providers
Dental Providers
Practice location
190 Park Ave
Portland, ME 04102-1000
Phone: (207) 874-1028
Approximate (ZIP-level) locationGet directions
Mailing address
10 Lone Pine Ln
Yarmouth, ME 04096-6119
Registry dates
- Enumerated
- 2007-01-22
- Last updated
- 2021-02-04
- Certified
- 2021-02-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.