Organization
CANYON DENTAL INC.
Active
Other names
Canyon Dental
Organization subpart
No
Provider details
NPI number
Authorized official
GABRIEL DE LA VARA (DENTIST)
(626) 369-8617
Entity
Organization
Contact information
Practice address
2219 S HACIENDA BLVD STE 202, HACIENDA HEIGHTS, CA 91745-4610
(626) 369-8617
(626) 369-0257
Mailing address
2219 S HACIENDA BLVD STE 202, HACIENDA HEIGHTS, CA 91745-4610
(626) 369-8617
(626) 369-0257
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/22/2018
Last updated
05/22/2018
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