Organization
CANYON CREST FAMILY DENTAL & AESTHETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRAVIS LYLE BOYER DMD (OWNER)
(719) 924-8858
Entity
Organization
Contact information
Practice address
332 S ORCHARD SPRINGS DR STE 110, PUEBLO WEST, CO 81007-6154
(719) 924-8858
Mailing address
332 S ORCHARD SPRINGS DR STE 110, PUEBLO WEST, CO 81007-6154
(719) 924-8858
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
00202790
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07178506
—
CO
Enumeration date
03/23/2018
Last updated
03/23/2018
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