| Canyon Modern Dentistry & Orthodontics | |
|
17081 W Greenway Rd Suite 120 Surprise AZ 85388-9612 | |
| (623) 546-8400 | |
| (623) 214-5830 |
| Full Name | Canyon Modern Dentistry & Orthodontics |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 17081 W Greenway Rd, Surprise, Arizona |
| Authorized Official Name and Position | Mohammed Reza Khakwani (GENERAL DENTIST) |
| Authorized Official Contact | 3167276886 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Canyon Modern Dentistry & Orthodontics 17081 W Greenway Rd Suite 120 Surprise AZ 85388-9612 Ph: (623) 546-8400 | Canyon Modern Dentistry & Orthodontics 17081 W Greenway Rd Suite 120 Surprise AZ 85388-9612 Ph: (623) 546-8400 |
| NPI Number | 1366848897 |
|---|---|
| Provider Enumeration Date | 11/11/2014 |
| Last Update Date | 11/11/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366848897 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D009075 (Arizona) | Primary |
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