SUN WEST DENTAL III, LLC
NPI: 1790827699
· MESA, AZ 85203
· Dentist
· NPI assigned 02/14/2007
$40.00
Total Medicaid Paid
Provider Details
| Authorized Official | DALTON, TRACEY (CREDENTIALING SPECIALIST) |
| Parent Organization | SUN WEST DENTAL CENTER III, LLC |
| NPI Enumeration Date | 02/14/2007 |
Related Entities
Other providers sharing the same authorized official: DALTON, TRACEY
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
12 |
$0.00 |
| 2020 |
25 |
$40.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
37 |
37 |
$40.00 |