# SURPRISE MODERN DENTISTRY LLP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Surprise Modern Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376200261
- **Authorized official:** JOSHUA J SHAW DMD (OWNER)
- **Authorized official phone:** (623) 777-3329

## Contact information

- **Practice address:** 13733 N PRASADA PKWY STE 108, SURPRISE, AZ 85388-8007
- **Practice address phone:** (623) 777-3329
- **Practice address fax:** (623) 900-2676
- **Mailing address:** PO BOX 920050, DALLAS, TX 75392-0050
- **Mailing address phone:** (714) 845-8892
- **Mailing address fax:** (303) 952-0892

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 11/26/2021
- **Last updated:** 11/26/2021