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General NPI Number Information
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NPI Number | 1578126470
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Entity Type | Organization
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Legal Business Name | SCOTTSDALE PEDIATRIC DENTAL ASSOCIATES INC
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Dates
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Enumeration Date | 04/16/2019
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Last Update Date | 04/16/2019
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Provider Practice Location Address
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Address Line | 9280 E RAINTREE, SUITE 108
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City | SCOTTSDALE
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State | AZ
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Zip | 85260
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Country | US
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Telephone | 480-443-9080
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Fax |
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Provider Business Mailing Address
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Address Line | 9280 E RAINTREE, SUITE 108
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City | SCOTTSDALE
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State | AZ
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Zip | 85260
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Country | US
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Telephone | 480-443-9080
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SULIEMAN KASSISIEH
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Credential | DDS, MS
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Telephone | 480-948-4010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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