Provider Demographics
NPI:1437378858
Name:A-MCDOWELL DENTAL
Entity type:Organization
Organization Name:A-MCDOWELL DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:SALIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-273-0013
Mailing Address - Street 1:125 WEST MCDOWELL ROAD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1223
Mailing Address - Country:US
Mailing Address - Phone:602-273-0013
Mailing Address - Fax:602-258-7493
Practice Address - Street 1:125 WEST MCDOWELL ROAD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1223
Practice Address - Country:US
Practice Address - Phone:602-273-0013
Practice Address - Fax:602-258-7493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD3476122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ089715OtherAHCCCS