Canon Kids Dental & Braces, PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

CANON KIDS DENTAL & BRACES, PC

Practice address

1201 Royal Gorge Blvd
Canon City, CO 81212-3835

Phone

(719) 285-0994

Fax

(719) 285-0996

NPI assigned

Nov 13, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Enjoli Guillory

Title

Director of RCM

Phone

(719) 464-0753

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1762992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762992000000",
    "number": "1003776097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2041 PEPPER LN",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810053276",
            "telephone_number": "719-285-0994",
            "fax_number": "719-285-0996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 ROYAL GORGE BLVD",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812123835",
            "telephone_number": "719-285-0994",
            "fax_number": "719-285-0996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANON KIDS DENTAL & BRACES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-13",
        "last_updated": "2025-11-13",
        "certification_date": "2025-11-13",
        "status": "A",
        "authorized_official_last_name": "GUILLORY",
        "authorized_official_first_name": "ENJOLI",
        "authorized_official_title_or_position": "DIRECTOR OF RCM",
        "authorized_official_telephone_number": "719-464-0753"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Canon Professional Wellness Clinic LLC
• Canon Professional, L.L.C.
• Tiffany Diane Cardinal
• Laurie Carle, PT
• Eric Carlson, MD

• Dentist in Canon City, CO
• Providers in Canon City, CO by specialty
• Dentist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.