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General NPI Number Information
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NPI Number | 1770005233
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Entity Type | Organization
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Legal Business Name | SURPRISE IMPLANTS & FAMILY DENTISTRY
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Dates
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Enumeration Date | 07/16/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 14967 W BELL RD STE 100
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City | SURPRISE
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State | AZ
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Zip | 85374
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Country | US
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Telephone | 623-233-6236
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Fax | 480-248-3133
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Provider Business Mailing Address
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Address Line | 14967 W BELL RD STE 100
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City | SURPRISE
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State | AZ
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Zip | 85374-3201
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Country | US
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Telephone | 623-233-6236
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Fax | 480-248-3133
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHREEDEVI THULASIDAS
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Credential | DDS
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Telephone | 480-815-5222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D07677
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License Number State | AZ
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