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General NPI Number Information
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NPI Number | 1841274487
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Entity Type | Individual
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Provider Name | MARK ALFRED SHOUSHA D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 1100 N ALMA SCHOOL RD STE 7
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City | CHANDLER
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State | AZ
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Zip | 85224-3169
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Country | US
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Telephone | 602-819-2036
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Fax | 480-857-3866
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Provider Business Mailing Address
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Address Line | PO BOX 7510
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City | CHANDLER
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State | AZ
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Zip | 85246-7510
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Country | US
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Telephone | 602-819-2036
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Fax | 480-857-3866
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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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