DR. ANGELA MICHELLE ILLUZZI-RUSSO DDS NPI 1811041726

NPI Information

  • NPI: 1811041726
  • Provider Name: DR. ANGELA MICHELLE ILLUZZI-RUSSO, DDS
  • Classification: Dentist - 1223S0112X
  • Specialization: Oral and Maxillofacial Surgery
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 190 PARK AVE
    PORTLAND, ME
    ZIP 04102
  • Phone: (207) 874-1028

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NPI Details

DR. Angela Michelle Illuzzi-russo, DDS is an oral and maxillofacial surgery dentist in Portland, ME. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. DR. Angela Michelle Illuzzi-russo, DDS NPI is 1811041726. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

190 PARK AVE
PORTLAND, ME
ZIP 04102-000
Phone: (207) 874-1028

The NPI 1811041726 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/22/2007 and was last updated on 2/4/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223S0112XDentistOral and Maxillofacial Surgery052809NEW YORKNo
21223S0112XDentistOral and Maxillofacial Surgery22DI02347100NEW JERSEYNo
31223S0112XDentistOral and Maxillofacial SurgeryDEN4836MAINEYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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