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Organization
CANYON FAMILY DENTAL LLC
Active
Organization
CANYON FAMILY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAITH GASKINS (DIRECTOR OF CREDENTIALING)
(972) 869-3789
Entity
Organization
Contact information
Practice address
500 N ESTRELLA PKWY STE B1, GOODYEAR, AZ 85338-4136
(623) 880-0782
Mailing address
500 N ESTRELLA PKWY STE B1, GOODYEAR, AZ 85338-4136
(623) 880-0782
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/03/2019
Last updated
10/03/2019
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