| Canyon City Dental Care | |
|
706 North Azusa Ave Azusa CA 91702-2507 | |
| (626) 334-7310 | |
| (626) 334-7311 |
| Full Name | Canyon City Dental Care |
|---|---|
| Speciality | Dentist |
| Location | 706 North Azusa Ave, Azusa, California |
| Authorized Official Name and Position | Enoma A Alade (OWNER DENTIST) |
| Authorized Official Contact | 6263347310 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Canyon City Dental Care 706 North Azusa Ave Azusa CA 91702-2507 Ph: (626) 334-7310 | Canyon City Dental Care 706 North Azusa Ave Azusa CA 91702-2507 Ph: (626) 334-7310 |
| NPI Number | 1285957712 |
|---|---|
| Provider Enumeration Date | 03/11/2010 |
| Last Update Date | 03/11/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285957712 | NPI | - | NPPES |
| G933866-01 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 47979 (California) | Primary |
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Canyon City Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 706 N Azusa Ave, Azusa, CA 91702 Phone: 626-334-7310 | |
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