Organization
SURPRISE FAMILY DENTISTRY
Active
Other names
Surprise Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHREEDEVI THULASIDAS DDS MS (DENTIST)
(623) 556-5510
Entity
Organization
Contact information
Practice address
18775 N REEMS RD STE 300, SURPRISE, AZ 85374-8647
(623) 556-5510
Mailing address
18775 N REEMS RD STE 300, SURPRISE, AZ 85374-8647
(623) 556-5510
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D05975
AZ
122300000X
Dentist
D07677
AZ
1223G0001X
General Practice Dentistry
D05975
AZ
1223G0001X
General Practice Dentistry
D07677
AZ
1223P0700X
Prosthodontics
D07677
AZ
Other
Enumeration date
02/26/2016
Last updated
11/01/2016
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