=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558256842
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHEYDA MOTEVALLI DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2025
-----------------------------------------------------
Last Update Date | 06/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5220 N DYSART RD STE 160
-----------------------------------------------------
City | LITCHFIELD PARK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85340-3048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-935-0500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11232 N 136TH PL
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85259-4647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | D012509
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------