Canyon Vista Dental

NPI #1518515212 in Sierra Vista, Arizona

Provider Information

NPI Number: 1518515212
Entity Type: Organization
Organization Name: Canyon Vista Dental
Primary Specialty: Dentist - General Practice
Enumeration Date: Aug 27, 2019
Last Updated: Aug 27, 2019

Practice Location

Address: 1993 S FRONTAGE ROAD
Address 2: SUITE 208
City: Sierra Vista
State: Arizona
ZIP Code: 85635
Phone: (520) 458-4646

Authorized Official

Name: MARVIN BLANE JACKSON
Title: DDS/OWNER
Phone: (435) 637-2100

Specialties & Taxonomy Codes

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

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