Provider Demographics
NPI:1548792666
Name:ARROWHEAD PROSTHODONTICS PLLC
Entity Type:Organization
Organization Name:ARROWHEAD PROSTHODONTICS PLLC
Other - Org Name:ARROWHEAD PROSTHODONTICS & DENTAL IMPLANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHREEDEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:THULASIDAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:623-266-9601
Mailing Address - Street 1:18555 N 79TH AVE STE A101
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8371
Mailing Address - Country:US
Mailing Address - Phone:623-266-9601
Mailing Address - Fax:
Practice Address - Street 1:18555 N 79TH AVE STE A101
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8371
Practice Address - Country:US
Practice Address - Phone:623-266-9601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD076771223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty