Provider Demographics
NPI:1568846244
Name:SCOTTSDALE AND SHEA DENTAL GROUP, LLP
Entity Type:Organization
Organization Name:SCOTTSDALE AND SHEA DENTAL GROUP, LLP
Other - Org Name:SCOTTSDALE AND SHEA DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MIAOULIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-544-2800
Mailing Address - Street 1:17000 RED HILL AVENUE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:949-474-1495
Practice Address - Street 1:11015 N SCOTTSDALE RD STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5196
Practice Address - Country:US
Practice Address - Phone:480-544-2800
Practice Address - Fax:480-544-1148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty