Provider Demographics
NPI:1699980920
Name:MADI, SHAHIN (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:SHAHIN
Middle Name:
Last Name:MADI
Suffix:
Gender:
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8236 N 62ND PL
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-2645
Mailing Address - Country:US
Mailing Address - Phone:480-215-2859
Mailing Address - Fax:
Practice Address - Street 1:23271 N SCOTTSDALE RD STE A106
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4484
Practice Address - Country:US
Practice Address - Phone:480-544-2383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX347611223P0300X
NVS4-83C1223P0300X, 1223P0300X
AZD71751223P0300X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1699980920Medicaid
AZ1699980920Medicare PIN
AZ1699980920Medicaid
AZ1699980920Medicare Oscar/Certification
AZ1699980920Medicare UPIN