Healthcare Provider Details

I. General information

NPI: 1922563691
Provider Name (Legal Business Name): SURPRISE IMPLANTS & PROSTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14967 W BELL RD STE 100
SURPRISE AZ
85374-3201
US

IV. Provider business mailing address

14967 W BELL RD STE 100
SURPRISE AZ
85374-3201
US

V. Phone/Fax

Practice location:
  • Phone: 623-233-6236
  • Fax: 623-670-5901
Mailing address:
  • Phone: 623-233-6236
  • Fax: 623-670-5901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. SHREEDEVI THULAISDAS
Title or Position: OWNER
Credential: DDS.MS
Phone: 623-233-6236