Healthcare Provider Details

I. General information

NPI: 1043303001
Provider Name (Legal Business Name): SHREEDEVI THULASIDAS DDS.MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34597 N 60TH ST STE 101
SCOTTSDALE AZ
85266-5241
US

IV. Provider business mailing address

34597 N 60TH ST STE 101
SCOTTSDALE AZ
85266-5241
US

V. Phone/Fax

Practice location:
  • Phone: 480-488-9655
  • Fax:
Mailing address:
  • Phone: 480-488-9655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberD07677
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: