MEDICARE: SUN WEST DENTAL CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D4013	AZ

General Provider Information

NPI Number	:	1093858805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN WEST DENTAL CENTER, LLC

Provider Business Mailing Address
First Line	:	600 E UNIVERSITY DR
Second Line	:	CORP
City	:	MESA
State	:	AZ
Zip	:	85203-7927
Country	:	US
Telephone Number	:	480-610-6440
Fax Number	:	480-610-6516

Provider Business Practice Location Address
First Line	:	13000 N 103RD AVE
Second Line	:	# 85
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3024
Country	:	US
Telephone Number	:	623-583-6666
Fax Number	:	623-933-8188

Authorized Official
Title or Position	:	SENIOR PROVIDER
Name	:	DR. SCOTT LEWIS DALTON
Credential	:	D.D.S.
Telephone Number	:	623-583-6666

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	08/22/2020

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