Individual
DR. RUSSELL W RODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
26232 N TATUM BLVD, SUITE 400, PHOENIX, AZ 85050-7501
(480) 515-0404
(480) 515-2587
Mailing address
26232 N TATUM BLVD, SUITE 400, PHOENIX, AZ 85050-7501
(480) 515-0404
(480) 515-2587
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4906
AZ
Other
Enumeration date
08/22/2006
Last updated
07/08/2007
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