# MIRROR IMAGE DENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891594016
- **Authorized official:** DR. SHAWN MICHAEL MAULE DDS (CEO / OWNER DENTIST)
- **Authorized official phone:** (602) 705-9168

## Contact information

- **Practice address:** 4710 E CACTUS RD, PHOENIX, AZ 85032-7706
- **Practice address phone:** (480) 442-0225
- **Mailing address:** 1601 E POTTER DR, PHOENIX, AZ 85024-4334
- **Mailing address phone:** (602) 705-9168

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/11/2025
- **Last updated:** 03/11/2025