Healthcare Provider Details

I. General information

NPI: 1518438118
Provider Name (Legal Business Name): CAVE CREEK FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2018
Last Update Date: 12/09/2018
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: 480-248-3133
Mailing address:
  • Phone: 480-488-9655
  • Fax: 480-248-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SHREEDEVI THULASIDAS
Title or Position: DENTIST
Credential: DDS
Phone: 480-488-9655