Healthcare Provider Details

I. General information

NPI: 1568518587
Provider Name (Legal Business Name): SUNCOAST DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 10/08/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 N PEBBLECREEK PKWY STE A-11
GOODYEAR AZ
85395
US

IV. Provider business mailing address

2025 N PEBBLECREEK PKWY STE A-11
GOODYEAR AZ
85395
US

V. Phone/Fax

Practice location:
  • Phone: 623-214-9979
  • Fax: 623-935-0774
Mailing address:
  • Phone: 623-214-9979
  • Fax: 623-935-0774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0090
License Number StateAZ

VIII. Authorized Official

Name: LUZ YENNY CHERWINSKI
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 623-533-2063