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General NPI Number Information
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NPI Number | 1568846244
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Entity Type | Organization
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Legal Business Name | SCOTTSDALE AND SHEA DENTAL GROUP, LLP
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Dates
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Enumeration Date | 07/13/2015
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Last Update Date | 07/13/2015
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Provider Practice Location Address
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Address Line | 11015 N SCOTTSDALE RD STE 101
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-5196
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Country | US
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Telephone | 480-544-2800
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Fax | 480-544-1148
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Provider Business Mailing Address
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Address Line | 17000 RED HILL AVENUE
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City | IRVINE
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State | CA
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Zip | 92614
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Country | US
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Telephone | 714-845-8890
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Fax | 949-474-1495
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Authorized Official
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Title or Position | OWNER DOCTOR
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Name | DR. ANTHONY G MIAOULIS
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Credential | DMD
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Telephone | 480-544-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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