# CANYON TRAILS FAMILY DENTAL, LLC

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

## Provider details

- **NPI number:** 1104282425
- **Authorized official:** JOHN E BALLARD (CFO, CIO)
- **Authorized official phone:** (480) 889-9457

## Contact information

- **Practice address:** 500 N ESTRELLA PKWY, SUITE B-1, GOODYEAR, AZ 85338-4135
- **Practice address phone:** (623) 882-0782
- **Practice address fax:** (623) 882-0878
- **Mailing address:** 4435 E HOLMES AVE, SUITE \#200, MESA, AZ 85206-3372
- **Mailing address phone:** (480) 889-9457
- **Mailing address fax:** (480) 696-5505

## Taxonomy

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

## Other

- **Enumeration date:** 01/04/2016
- **Last updated:** 01/04/2016