Canyon Crest Family Dental & Aesthetics

Primary specialty

DentistTaxonomy code 122300000X

License

00202790

Legal business name

CANYON CREST FAMILY DENTAL & AESTHETICS

Practice address

332 S Orchard Springs Dr Ste 110
Pueblo West, CO 81007-6154

Phone

(719) 924-8858

NPI assigned

Mar 23, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Travis Lyle Boyer, DMD

Title

Owner

Phone

(719) 924-8858

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1521763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521763200000",
    "number": "1255835187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "332 S ORCHARD SPRINGS DR STE 110",
            "city": "PUEBLO WEST",
            "state": "CO",
            "postal_code": "810076154",
            "telephone_number": "719-924-8858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "332 S ORCHARD SPRINGS DR STE 110",
            "city": "PUEBLO WEST",
            "state": "CO",
            "postal_code": "810076154",
            "telephone_number": "719-924-8858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON CREST FAMILY DENTAL & AESTHETICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-23",
        "last_updated": "2018-03-23",
        "status": "A",
        "authorized_official_last_name": "BOYER",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_middle_name": "LYLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-924-8858",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": "00202790",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07178506",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gloria R Cappetto, DIPL. AC., L AC.
• Chelsea N Cardenas
• Debra Ann Carpenter, N.P.,D.C.
• Megan Marie Carson

• Dentist in Pueblo West, CO
• Providers in Pueblo West, CO by specialty
• Dentist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2018; 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.