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General NPI Number Information
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NPI Number | 1972930147
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Entity Type | Organization
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Legal Business Name | SCOTTSDALE PROSTHODONTICS AND FAMILY DENTISTRY
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 02/04/2016
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Provider Practice Location Address
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Address Line | 34597 N 60TH ST STE 101
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City | SCOTTSDALE
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State | AZ
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Zip | 85266-5241
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Country | US
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Telephone | 480-488-9655
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Fax | 480-575-1130
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Provider Business Mailing Address
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Address Line | 34597 N 60TH ST STE 101
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City | SCOTTSDALE
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State | AZ
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Zip | 85266-5241
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Country | US
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Telephone | 480-488-9655
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Fax | 480-575-1130
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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,MS
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Telephone | 480-815-5223
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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 | D07677
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D07677
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | D07677
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License Number State | AZ
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