Healthcare Provider Details

I. General information

NPI: 1699980920
Provider Name (Legal Business Name): SHAHIN MADI D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23271 N SCOTTSDALE RD STE A106
SCOTTSDALE AZ
85255-4484
US

IV. Provider business mailing address

8236 N 62ND PL
PARADISE VALLEY AZ
85253-2645
US

V. Phone/Fax

Practice location:
  • Phone: 480-544-2383
  • Fax:
Mailing address:
  • Phone: 480-215-2859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number34761
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberS4-83C
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD7175
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: