NPIMap

Organization Active NPI

Canyon River Dental

  • General Practice Dentistry
  • Provo, UT
National Provider Identifier
1306277546
Registry record updated Dec 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
CANYON RIVER DENTAL
Practice address
3707 N Canyon Rd
Suite 7D
Provo, UT 84604-4592
Phone
(801) 221-5859
Fax
(801) 221-7091
NPI assigned
Dec 12, 2013
Last updated
Dec 12, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
EL AL CHINN EEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 12, 2013

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

Authorized official

Name
Mark C Lomenick
Title
Cfo
Phone
(801) 221-5859

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

3707 N Canyon Rd
Suite 7D
Provo, UT 84604-4592

Mailing address

3707 N Canyon Rd
Suite 7D
Provo, UT 84604-4592
Phone (801) 221-5859

National Provider Directory

National Provider Directory
Tax ID family
Canyon River Dental3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3707 N Canyon Rd
Ste 7D
Provo, UT 84604
Phone (801) 221-5859

NPI Registry JSON

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

{
    "created_epoch": "1386806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386806400000",
    "number": "1306277546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3707 N CANYON RD",
            "address_2": "SUITE 7D",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846044592",
            "telephone_number": "801-221-5859",
            "fax_number": "801-221-7091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3707 N CANYON RD",
            "address_2": "SUITE 7D",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846044592",
            "telephone_number": "801-221-5859",
            "fax_number": "801-221-7091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON RIVER DENTAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EL AL CHINN EEM",
        "enumeration_date": "2013-12-12",
        "last_updated": "2013-12-12",
        "status": "A",
        "authorized_official_last_name": "LOMENICK",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "801-221-5859"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2013; 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.