Organization
CANON KIDS DENTAL & BRACES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ENJOLI GUILLORY (DIRECTOR OF RCM)
(719) 464-0753
Entity
Organization
Contact information
Practice address
1201 ROYAL GORGE BLVD, CANON CITY, CO 81212-3835
(719) 285-0994
(719) 285-0996
Mailing address
2041 PEPPER LN, PUEBLO, CO 81005-3276
(719) 285-0994
(719) 285-0996
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
11/13/2025
Last updated
11/13/2025
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