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General NPI Number Information
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NPI Number | 1811199284
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Entity Type | Organization
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Legal Business Name | MARK A SHOUSHA, DDS PC
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 07/15/2009
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Provider Practice Location Address
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Address Line | 1100 N ALMA SCHOOL RD SUITE 7
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City | CHANDLER
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State | AZ
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Zip | 85224-3171
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Country | US
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Telephone | 480-855-4444
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Fax | 480-857-3866
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Provider Business Mailing Address
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Address Line | 1100 N ALMA SCHOOL RD SUITE 7
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City | CHANDLER
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State | AZ
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Zip | 85224-3171
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Country | US
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Telephone | 480-855-4444
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Fax | 480-857-3866
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK ALFRED SHOUSHA
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Credential | DDS
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Telephone | 480-855-4444
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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 | 4329
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License Number State | AZ
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