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Organization

CANYON ROAD DENTAL PLLC

Active
Other names
Canyon Road Dental
Organization subpart
No

Provider details

NPI number
Authorized official
FAITH GASKINS (DIRECTOR OF CREDENTIALING)
(972) 869-3789
Entity
Organization

Contact information

Practice address
3707 N CANYON RD STE 2A, PROVO, UT 84604-4525
(801) 997-6728
(385) 374-1555
Mailing address
3707 N CANYON RD STE 2A, PROVO, UT 84604-4525
(801) 997-6728
(385) 374-1555

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary

Other

Enumeration date
05/13/2021
Last updated
05/13/2021
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