# AESTHETIC FAMILY DENTISTRY PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** AESTHETIC FAMILY DENTISTRY PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1518105691
- **Legal business name:** AESTHETIC FAMILY DENTISTRY PC
- **Authorized official:** DR. RUSSELL W. RODERICK DMD (DOCTOR)
- **Authorized official phone:** (480) 515-0404

## Contact information

- **Practice address:** 26232 N TATUM BLVD STE 400, PHOENIX, AZ 85050-7504
- **Practice address phone:** (480) 515-0404
- **Practice address fax:** (480) 515-2587
- **Mailing address:** 26232 N TATUM BLVD STE 400, PHOENIX, AZ 85050-7504
- **Mailing address phone:** (480) 515-0404
- **Mailing address fax:** (480) 515-2587

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 4906 | AZ | Yes |

## Other

- **Enumeration date:** 01/28/2009
- **Last updated:** 01/28/2009