Provider Demographics
NPI:1699817213
Name:SUN WEST DENTAL III, LLC DBA SUN WEST DENTAL
Entity Type:Organization
Organization Name:SUN WEST DENTAL III, LLC DBA SUN WEST DENTAL
Other - Org Name:SUN WEST DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
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:623-640-0267
Mailing Address - Street 1:2175 N ALMA SCHOOL RD STE C108
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2880
Mailing Address - Country:US
Mailing Address - Phone:623-640-0267
Mailing Address - Fax:602-354-5860
Practice Address - Street 1:2175 N. ALMA SCHOOL RD. # C108
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-782-6200
Practice Address - Fax:480-792-1444
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNWEST DENTAL CENTER III, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-12
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty