# CACTUS CANYON DENTAL

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

## Provider details

- **NPI number:** 1346893575
- **Authorized official:** MRS. THERESA MARIE COLLINS DMD (DENTIST/OWNER)
- **Authorized official phone:** (503) 267-7559

## Contact information

- **Practice address:** 2043 E SOUTHERN AVE, STE. C, TEMPE, AZ 85282
- **Practice address phone:** (480) 730-0553
- **Practice address fax:** (480) 839-3319
- **Mailing address:** 2043 E SOUTHERN AVE, STE. C, TEMPE, AZ 85282
- **Mailing address phone:** (480) 730-0553
- **Mailing address fax:** (480) 839-3319

## Taxonomy

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

## Other

- **Enumeration date:** 07/17/2019
- **Last updated:** 07/17/2019