Individual
DR. BROCK TERRY RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
13761 N LITCHFIELD RD STE 103, SURPRISE, AZ 85379-4272
(623) 975-3933
Mailing address
2940 W WAGONER RD, PHOENIX, AZ 85053-1122
(623) 518-5233
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D012505
AZ
Other
Enumeration date
05/29/2025
Last updated
05/29/2025
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