Canyon Family Dental LLC
Dentist, General Practice in Goodyear, AZ. Organization (NPI-2).
NPI number1982245676
StatusActive
Last updated in NPPESOct 3, 2019
Details
- NPI
- 1982245676
- Entity type
- Organization (NPI-2)
- Legal business name
- Canyon Family Dental LLC
- Organization subpart
- No
- Enumeration date
- Oct 3, 2019
- Last updated
- Oct 3, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Practice location
500 N Estrella Pkwy Ste B1Goodyear, AZ 85338-4136
Phone 623-880-0782
Mailing address
500 N Estrella Pkwy Ste B1Goodyear, AZ 85338-4136
Phone 623-880-0782
Authorized official
Faith Gaskins
Director Of Credentialing
9728693789
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