Organization
CANYON VISTA DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARVIN BLANE JACKSON (DDS/OWNER)
(435) 637-2100
Entity
Organization
Contact information
Practice address
1993 S FRONTAGE ROAD, SUITE 208, SIERRA VISTA, AZ 85635
(520) 458-4646
Mailing address
230 N FAIRGROUND ROAD, PRICE, UT 84501
(435) 637-2100
(435) 637-5007
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/27/2019
Last updated
08/27/2019
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