Canyon Trails Family Dental, LLC

NPI #1104282425 in Goodyear, Arizona

Provider Information

NPI Number: 1104282425
Entity Type: Organization
Organization Name: Canyon Trails Family Dental, LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Jan 4, 2016
Last Updated: Jan 4, 2016

Practice Location

Address: 500 N ESTRELLA PKWY
Address 2: SUITE B-1
City: Goodyear
State: Arizona
ZIP Code: 85338-4135
Phone: (623) 882-0782

Authorized Official

Name: JOHN E BALLARD
Title: CFO, CIO
Phone: (480) 889-9457

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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