# SUN WEST DENTAL SAN TAN

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821459421
- **Authorized official:** TRACEY DALTON (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (623) 640-0267

## Contact information

- **Practice address:** 2510 E HUNT HWY, SUITE \#28, SAN TAN VALLEY, AZ 85143-5206
- **Practice address phone:** (480) 355-0761
- **Practice address fax:** (480) 784-3883
- **Mailing address:** 2510 E HUNT HWY STE 28, SAN TAN VALLEY, AZ 85143-5208
- **Mailing address phone:** (623) 640-0267
- **Mailing address fax:** (602) 344-9713

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 03/10/2016
- **Last updated:** 06/22/2021