Provider Demographics
NPI:1376685560
Name:SUN WEST DENTAL CENTER 2, LLC
Entity type:Organization
Organization Name:SUN WEST DENTAL CENTER 2, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SKAALEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-923-2400
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 1:3227 E BELL RD
Practice Address - Street 2:# 120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2700
Practice Address - Country:US
Practice Address - Phone:602-923-2400
Practice Address - Fax:602-923-2410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5795122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty