# CANYON VISTA DENTISTRY AND ORTHODONTICS,LLP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Canyon Vista Dentistry and Orthodontics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194048744
- **Authorized official:** DR. TODD R COCKRELL DMD (OWNER DOCTOR)
- **Authorized official phone:** (626) 561-6767

## Contact information

- **Practice address:** 25155 N 67TH AVE STE 142, PHOENIX, AZ 85083-1065
- **Practice address phone:** (626) 561-6767
- **Practice address fax:** (623) 561-1703
- **Mailing address:** 2860 MICHELLE FL 2, IRVINE, CA 92606-1008
- **Mailing address phone:** (714) 368-2077

## Taxonomy

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

## Other

- **Enumeration date:** 03/10/2010
- **Last updated:** 03/10/2010