NPIMap

Organization Active NPI

Canyon Modern Dentistry & Orthodontics

  • Dental Clinic/Center
  • Surprise, AZ
National Provider Identifier
1366848897
Registry record updated Nov 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
D009075 Issued in AZ
Legal business name
CANYON MODERN DENTISTRY & ORTHODONTICS
Practice address
17081 W Greenway Rd
Suite 120
Surprise, AZ 85388-9612
Phone
(623) 546-8400
Fax
(623) 214-5830
NPI assigned
Nov 11, 2014
Last updated
Nov 11, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2014

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

Authorized official

Name
Dr. Mohammed Reza Khakwani, DMDNPI 1538557525
Title
General Dentist
Phone
(316) 727-6886

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X D009075 AZ Primary

Addresses

Primary practice location

17081 W Greenway Rd
Suite 120
Surprise, AZ 85388-9612

Mailing address

17081 W Greenway Rd
Suite 120
Surprise, AZ 85388-9612
Phone (623) 546-8400

National Provider Directory

National Provider Directory
Tax ID family
Amanda Girardi5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

17081 W Greenway Rd
Ste 120
Surprise, AZ 85388
Phone (623) 546-8400

Practitioners & affiliated clinicians

Practitioners 8

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": "1415664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415664000000",
    "number": "1366848897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17081 W GREENWAY RD",
            "address_2": "SUITE 120",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853889612",
            "telephone_number": "623-546-8400",
            "fax_number": "623-214-5830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17081 W GREENWAY RD",
            "address_2": "SUITE 120",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853889612",
            "telephone_number": "623-546-8400",
            "fax_number": "623-214-5830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON MODERN DENTISTRY & ORTHODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-11",
        "last_updated": "2014-11-11",
        "status": "A",
        "authorized_official_last_name": "KHAKWANI",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_middle_name": "REZA",
        "authorized_official_title_or_position": "GENERAL DENTIST",
        "authorized_official_telephone_number": "316-727-6886",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "AZ",
            "license": "D009075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Surprise, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2014; 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.