Provider Demographics
NPI:1043303001
Name:THULASIDAS, SHREEDEVI (DDSMS)
Entity type:Individual
Prefix:DR
First Name:SHREEDEVI
Middle Name:
Last Name:THULASIDAS
Suffix:
Gender:F
Credentials:DDSMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34597 N 60TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-5241
Mailing Address - Country:US
Mailing Address - Phone:480-488-9655
Mailing Address - Fax:
Practice Address - Street 1:34597 N 60TH ST STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-5241
Practice Address - Country:US
Practice Address - Phone:480-488-9655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD076771223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics