Canyon Road Dental Pllc

NPI #1700450905 in Provo, Utah

Provider Information

NPI Number: 1700450905
Entity Type: Organization
Organization Name: Canyon Road Dental Pllc
Primary Specialty: Dentist - General Practice
Enumeration Date: May 13, 2021
Last Updated: May 13, 2021

Practice Location

Address: 3707 N CANYON RD STE 2A
City: Provo
State: Utah
ZIP Code: 84604-4525
Phone: (801) 997-6728

Authorized Official

Name: FAITH GASKINS
Title: DIRECTOR OF CREDENTIALING
Phone: (972) 869-3789

Specialties & Taxonomy Codes

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

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