Provider Demographics
NPI:1770005233
Name:SURPRISE IMPLANTS & FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SURPRISE IMPLANTS & FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
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
Authorized Official - Phone:480-815-5222
Mailing Address - Street 1:14967 W BELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-3201
Mailing Address - Country:US
Mailing Address - Phone:623-233-6236
Mailing Address - Fax:480-248-3133
Practice Address - Street 1:14967 W BELL RD
Practice Address - Street 2:STE 100
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374
Practice Address - Country:US
Practice Address - Phone:623-233-6236
Practice Address - Fax:480-248-3133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD07677261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental