Provider Demographics
NPI:1689716508
Name:SUN WEST DENTAL IV, LLC
Entity Type:Organization
Organization Name:SUN WEST DENTAL IV, LLC
Other - Org Name:SUNWEST DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-680-3977
Mailing Address - Street 1:14557 W GRAND AVE STE B106
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-7104
Mailing Address - Country:US
Mailing Address - Phone:623-374-3102
Mailing Address - Fax:
Practice Address - Street 1:14557 W GRAND AVE STE B106
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7104
Practice Address - Country:US
Practice Address - Phone:623-374-3102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD4013122300000X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty