Healthcare Provider Details

I. General information

NPI: 1568846244
Provider Name (Legal Business Name): SCOTTSDALE AND SHEA DENTAL GROUP, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11015 N SCOTTSDALE RD STE 101
SCOTTSDALE AZ
85254-5196
US

IV. Provider business mailing address

17000 RED HILL AVENUE
IRVINE CA
92614
US

V. Phone/Fax

Practice location:
  • Phone: 480-544-2800
  • Fax: 480-544-1148
Mailing address:
  • Phone: 714-845-8890
  • Fax: 949-474-1495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY G MIAOULIS
Title or Position: OWNER DOCTOR
Credential: DMD
Phone: 480-544-2800