Healthcare Provider Details

I. General information

NPI: 1679914337
Provider Name (Legal Business Name): ANTHONY GEORGE MIAOULIS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11015 N SCOTTSDALE RD STE 101
SCOTTSDALE AZ
85254
US

IV. Provider business mailing address

19637 N 15TH PL
PHOENIX AZ
85024-3647
US

V. Phone/Fax

Practice location:
  • Phone: 480-544-2800
  • Fax: 480-544-1148
Mailing address:
  • Phone: 480-747-4417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD008724
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: