# CANYON MODERN DENTISTRY, LLP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Canyon Modern Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194021170
- **Authorized official:** DR. JAMES B MALLORY JR. DMD (OWNER DOCTOR)
- **Authorized official phone:** (623) 546-8400

## Contact information

- **Practice address:** 17081 W GREENWAY RD STE 121, SURPRISE, AZ 85388-9612
- **Practice address phone:** (623) 546-8400
- **Practice address fax:** (623) 214-5830
- **Mailing address:** 2860 MICHELLE DRIVE 2ND FLOOR, IRVINE, CA 92606
- **Mailing address phone:** (714) 368-2077
- **Mailing address fax:** (714) 368-2092

## Taxonomy

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

## Other

- **Enumeration date:** 02/08/2011
- **Last updated:** 02/08/2011