Organization
CANYON TRAILS FAMILY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN E BALLARD (CFO, CIO)
(480) 889-9457
Entity
Organization
Contact information
Practice address
500 N ESTRELLA PKWY, SUITE B-1, GOODYEAR, AZ 85338-4135
(623) 882-0782
(623) 882-0878
Mailing address
4435 E HOLMES AVE, SUITE #200, MESA, AZ 85206-3372
(480) 889-9457
(480) 696-5505
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
AZ
Other
Enumeration date
01/04/2016
Last updated
01/04/2016
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