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General NPI Number Information
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NPI Number | 1689716508
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Entity Type | Organization
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Legal Business Name | SUN WEST DENTAL IV, LLC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 05/02/2023
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Provider Practice Location Address
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Address Line | 14557 W GRAND AVE STE B106
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City | SURPRISE
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State | AZ
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Zip | 85374-7104
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Country | US
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Telephone | 623-374-3102
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Fax |
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Provider Business Mailing Address
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Address Line | 14557 W GRAND AVE STE B106
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City | SURPRISE
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State | AZ
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Zip | 85374-7104
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Country | US
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Telephone | 623-374-3102
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF ADMINISTRATION
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Name | TRACEY DALTON
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Credential |
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Telephone | 623-680-3977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D4013
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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