| Canyon Trails Family Dental, Llc | |
|
500 N Estrella Pkwy Suite B-1 Goodyear AZ 85338-4135 | |
| (623) 882-0782 | |
| (623) 882-0878 |
| Full Name | Canyon Trails Family Dental, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 500 N Estrella Pkwy, Goodyear, Arizona |
| Authorized Official Name and Position | John E Ballard (CFO, CIO) |
| Authorized Official Contact | 4808899457 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Canyon Trails Family Dental, Llc 4435 E Holmes Ave Suite #200 Mesa AZ 85206-3372 Ph: (480) 889-9457 | Canyon Trails Family Dental, Llc 500 N Estrella Pkwy Suite B-1 Goodyear AZ 85338-4135 Ph: (623) 882-0782 |
| NPI Number | 1104282425 |
|---|---|
| Provider Enumeration Date | 01/04/2016 |
| Last Update Date | 01/04/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104282425 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (Arizona) | Primary |
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