| Canyon Creek Family Dentistry, P.a. | |
|
2091 N Collins Blvd Ste 100 Richardson TX 75080-2636 | |
| (972) 644-3800 | |
| (972) 644-3888 |
| Full Name | Canyon Creek Family Dentistry, P.a. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2091 N Collins Blvd Ste 100, Richardson, Texas |
| Authorized Official Name and Position | Afshin Azmoodeh (PRESIDENT) |
| Authorized Official Contact | 9726443800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Canyon Creek Family Dentistry, P.a. 2091 N Collins Blvd Ste 100 Richardson TX 75080-2636 Ph: (972) 644-3800 | Canyon Creek Family Dentistry, P.a. 2091 N Collins Blvd Ste 100 Richardson TX 75080-2636 Ph: (972) 644-3800 |
| NPI Number | 1659502730 |
|---|---|
| Provider Enumeration Date | 08/06/2009 |
| Last Update Date | 08/06/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659502730 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 20074 (Texas) | Primary |
| 1223P0221X | Dentist - Pediatric Dentistry | 24260 (Texas) | Secondary |
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Jay L. Nutt & C. Fred Pietsch, Dds, Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1231 E Belt Line Rd, Suite 103, Richardson, TX 75081 Phone: 972-690-8617 Fax: 972-690-6423 | |
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