Organization
CANYON MODERN DENTISTRY & ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMMED REZA KHAKWANI DMD (GENERAL DENTIST)
(316) 727-6886
Entity
Organization
Contact information
Practice address
17081 W GREENWAY RD, SUITE 120, SURPRISE, AZ 85388-9612
(623) 546-8400
(623) 214-5830
Mailing address
17081 W GREENWAY RD, SUITE 120, SURPRISE, AZ 85388-9612
(623) 546-8400
(623) 214-5830
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D009075
AZ
Other
Enumeration date
11/11/2014
Last updated
11/11/2014
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