| Canyon Road Dental Pllc | |
|
3707 N Canyon Rd Ste 2a Provo UT 84604-4525 | |
| (801) 997-6728 | |
| (385) 374-1555 |
| Full Name | Canyon Road Dental Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3707 N Canyon Rd Ste 2a, Provo, Utah |
| Authorized Official Name and Position | Faith Gaskins (DIRECTOR OF CREDENTIALING) |
| Authorized Official Contact | 9728693789 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Canyon Road Dental Pllc 3707 N Canyon Rd Ste 2a Provo UT 84604-4525 Ph: (801) 997-6728 | Canyon Road Dental Pllc 3707 N Canyon Rd Ste 2a Provo UT 84604-4525 Ph: (801) 997-6728 |
| NPI Number | 1700450905 |
|---|---|
| Provider Enumeration Date | 05/13/2021 |
| Last Update Date | 05/13/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700450905 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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