Canyon Trails Family Dental, LLC
Dentist, General Practice in Goodyear, AZ. Organization (NPI-2).
NPI number1104282425
StatusActive
Last updated in NPPESJan 4, 2016
Details
- NPI
- 1104282425
- Entity type
- Organization (NPI-2)
- Legal business name
- Canyon Trails Family Dental, LLC
- Organization subpart
- No
- Enumeration date
- Jan 4, 2016
- Last updated
- Jan 4, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | AZ | Yes |
Practice location
500 N Estrella PkwySuite B-1
Goodyear, AZ 85338-4135
Phone 623-882-0782 · Fax 623-882-0878
Mailing address
4435 E Holmes AveSuite #200
Mesa, AZ 85206-3372
Phone 480-889-9457 · Fax 480-696-5505
Authorized official
John E Ballard
Cfo, Cio
4808899457
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