Canyon River Dental

NPI #1306277546 in Provo, Utah

Provider Information

NPI Number: 1306277546
Entity Type: Organization
Organization Name: Canyon River Dental
Subpart: Yes (part of a larger organization)
Parent Organization: EL AL CHINN EEM
Primary Specialty: Dentist - General Practice
Enumeration Date: Dec 12, 2013
Last Updated: Dec 12, 2013

Practice Location

Address: 3707 N CANYON RD
Address 2: SUITE 7D
City: Provo
State: Utah
ZIP Code: 84604-4592
Phone: (801) 221-5859

Authorized Official

Name: MARK C LOMENICK
Title: CFO
Phone: (801) 221-5859

Specialties & Taxonomy Codes

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

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