NPIMap

Organization Active NPI

Canyon Trails Dental Care, PC

  • Dentist
  • Goodyear, AZ
National Provider Identifier
1043356058
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5594 Issued in AZ
Legal business name
CANYON TRAILS DENTAL CARE, PC
Practice address
500 N Estrella Pkwy
Suite B1
Goodyear, AZ 85338-4135
Phone
(623) 882-0782
NPI assigned
Jan 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mark Delwyn Wheeler, DMDNPI 1598825374
Title
Owner Dentist
Phone
(623) 882-0782

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 5594 AZ Primary

Addresses

Primary practice location

500 N Estrella Pkwy
Suite B1
Goodyear, AZ 85338-4135

Mailing address

500 N Estrella Pkwy
Suite B1
Goodyear, AZ 85338-4135
Phone (623) 882-0782

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043356058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N ESTRELLA PKWY",
            "address_2": "SUITE B1",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853384135",
            "telephone_number": "623-882-0782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N ESTRELLA PKWY",
            "address_2": "SUITE B1",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853384135",
            "telephone_number": "623-882-0782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON TRAILS DENTAL CARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WHEELER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "DELWYN",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "623-882-0782",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "5594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goodyear, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.