Healthcare Provider Details

I. General information

NPI: 1225961030
Provider Name (Legal Business Name): SAVANNAH LEIGH SHETTERLY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21001 N TATUM BLVD STE 80-1690
PHOENIX AZ
85050-5233
US

IV. Provider business mailing address

8644 W FULLAM ST
PEORIA AZ
85382-3035
US

V. Phone/Fax

Practice location:
  • Phone: 480-419-9200
  • Fax:
Mailing address:
  • Phone: 623-298-8808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD012871
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: