Provider Demographics
NPI:1285956524
Name:SUNWEST DENTAL CENTER, III LLC
Entity type:Organization
Organization Name:SUNWEST DENTAL CENTER, III LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:8256 E. HIGHWAY 69
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314
Mailing Address - Country:US
Mailing Address - Phone:602-354-5800
Mailing Address - Fax:602-354-5860
Practice Address - Street 1:8256 E. HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8631
Practice Address - Country:US
Practice Address - Phone:928-772-4433
Practice Address - Fax:928-772-5582
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNWEST DENTAL CENTER III, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-26
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty