Canyon River Dental

NPI #1821196197 in Provo, Utah

Provider Information

NPI Number: 1821196197
Entity Type: Organization
Organization Name: Canyon River Dental
Primary Specialty: Dentist
Enumeration Date: Sep 20, 2006
Last Updated: Aug 22, 2020

Practice Location

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

Authorized Official

Name: DR. RYAN T MANGRUM, DMD
Title: DENTIST
Phone: (801) 221-5859

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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