Provider Demographics
NPI:1093107237
Name:SUNWEST DENTAL CENTER
Entity Type:Organization
Organization Name:SUNWEST DENTAL CENTER
Other - Org Name:SUNWEST DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONAGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-640-0267
Mailing Address - Street 1:222 S MILL AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-2899
Mailing Address - Country:US
Mailing Address - Phone:623-640-0267
Mailing Address - Fax:602-354-5860
Practice Address - Street 1:4704 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2737
Practice Address - Country:US
Practice Address - Phone:480-889-9457
Practice Address - Fax:480-889-9493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8423122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty