Canyon Trails Family Dental, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

CANYON TRAILS FAMILY DENTAL, LLC

Practice address

500 N Estrella Pkwy
Suite B-1
Goodyear, AZ 85338-4135

Phone

(623) 882-0782

Fax

(623) 882-0878

NPI assigned

Jan 4, 2016

Organization subpart

No

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

Authorized official

Name

John E Ballard

Title

Cfo, Cio

Phone

(480) 889-9457

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1451865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451865600000",
    "number": "1104282425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4435 E HOLMES AVE",
            "address_2": "SUITE #200",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852063372",
            "telephone_number": "480-889-9457",
            "fax_number": "480-696-5505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N ESTRELLA PKWY",
            "address_2": "SUITE B-1",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853384135",
            "telephone_number": "623-882-0782",
            "fax_number": "623-882-0878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON TRAILS FAMILY DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-04",
        "last_updated": "2016-01-04",
        "status": "A",
        "authorized_official_last_name": "BALLARD",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CFO, CIO",
        "authorized_official_telephone_number": "480-889-9457"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Savannah Canez
• Canyon Falls LLC
• Canyon Family Dental LLC
• Canyon Pain and Spine
• Canyon Trails Dental Care, PC
• Bernard P Capulong, MBA
• Jaden Capwell
• Chris Cardella, OT
• Louise Cardenas
• Care One Behavioral Health Group Home LLC

• General Practice Dentistry in Goodyear, AZ
• Providers in Goodyear, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2016; 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.