Canyon Modern Dentistry, LLP

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

CANYON MODERN DENTISTRY, LLP

Practice address

17081 W Greenway Rd Ste 121
Surprise, AZ 85388-9612

Phone

(623) 546-8400

Fax

(623) 214-5830

NPI assigned

Feb 8, 2011

Organization subpart

No

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

Authorized official

Name

Dr. James B Mallory Jr., DMD

Title

Owner Doctor

Phone

(623) 546-8400

Specialties & licenses 1

Addresses

Other names 1

• Canyon Modern Dentistry Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mohammed Reza Khakwani, D.M.D.

  • Dentist
  • Surprise, AZ
  • NPI 1538557525

  General Practice

  NPD (past)
• Amish B Patel, DDS

  • General Practice Dentistry
  • Surprise, AZ
  • NPI 1033235734
  NPD (past)

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

{
    "created_epoch": "1297123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297123200000",
    "number": "1194021170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2860 MICHELLE DRIVE 2ND FLOOR",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "92606",
            "telephone_number": "714-368-2077",
            "fax_number": "714-368-2092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17081 W GREENWAY RD STE 121",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853889612",
            "telephone_number": "623-546-8400",
            "fax_number": "623-214-5830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON MODERN DENTISTRY, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-08",
        "last_updated": "2011-02-08",
        "status": "A",
        "authorized_official_last_name": "MALLORY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER DOCTOR",
        "authorized_official_telephone_number": "623-546-8400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyon Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amy Maria Cannatta, DC
• Victoria L Cannoles, LMT
• Cynthia Rae Cannon
• Lori Cannon, NP-C
• Canyon Modern Dentistry & Orthodontics
• Canyon Physical Therapy Surprise LLC
• Canyon Physical Therapy, Inc.
• Genevieve Cappello
• Karla Carbajal
• Kim Irene Carbajal, RDH

• General Practice Dentistry in Surprise, AZ
• Providers in Surprise, 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 Feb 8, 2011; 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.