Provider Demographics
NPI:1255597498
Name:AESTHETIC & FAMILY DENTRISTRY
Entity type:Organization
Organization Name:AESTHETIC & FAMILY DENTRISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:712-246-5587
Mailing Address - Street 1:119 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:IA
Mailing Address - Zip Code:51601-1701
Mailing Address - Country:US
Mailing Address - Phone:712-246-5587
Mailing Address - Fax:
Practice Address - Street 1:119 S ELM ST
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-1701
Practice Address - Country:US
Practice Address - Phone:712-246-5587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty