Provider Demographics
NPI:1932284783
Name:POULOS, STEVEN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:H
Last Name:POULOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9070 E DESERT COVE AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6227
Mailing Address - Country:US
Mailing Address - Phone:480-614-1122
Mailing Address - Fax:480-614-1226
Practice Address - Street 1:9070 E DESERT COVE AVE
Practice Address - Street 2:STE 105
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6710
Practice Address - Country:US
Practice Address - Phone:480-614-1122
Practice Address - Fax:480-614-1226
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice