Provider Demographics
NPI:1093858805
Name:SUN WEST DENTAL CENTER, LLC
Entity Type:Organization
Organization Name:SUN WEST DENTAL CENTER, LLC
Other - Org Name:SUN WEST DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-583-6666
Mailing Address - Street 1:600 E UNIVERSITY DR
Mailing Address - Street 2:CORP
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-7927
Mailing Address - Country:US
Mailing Address - Phone:480-610-6440
Mailing Address - Fax:480-610-6516
Practice Address - Street 1:13000 N 103RD AVE
Practice Address - Street 2:# 85
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3024
Practice Address - Country:US
Practice Address - Phone:623-583-6666
Practice Address - Fax:623-933-8188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD4013122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty