MEDICARE: DR. SHEYDA MOTEVALLI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D012509	AZ

General Provider Information

NPI Number	:	1558256842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHEYDA MOTEVALLI DMD

Provider Business Mailing Address
First Line	:	11232 N 136TH PL
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85259-4647
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5220 N DYSART RD STE 160
Second Line	:
City	:	LITCHFIELD PARK
State	:	AZ
Zip	:	85340-3048
Country	:	US
Telephone Number	:	623-935-0500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2025
Last Update Date	:	06/09/2025

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