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General NPI Number Information
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NPI Number | 1225961030
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Entity Type | Individual
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Provider Name | SAVANNAH LEIGH SHETTERLY DMD
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Gender | Female
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Dates
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Enumeration Date | 06/03/2026
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Last Update Date | 06/16/2026
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Provider Practice Location Address
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Address Line | 21001 N TATUM BLVD STE 80-1690
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City | PHOENIX
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State | AZ
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Zip | 85050-5233
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Country | US
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Telephone | 480-419-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 8644 W FULLAM ST
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City | PEORIA
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State | AZ
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Zip | 85382-3035
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Country | US
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Telephone | 623-298-8808
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D012871
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License Number State | AZ
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