Canyon Lake Dental PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

CANYON LAKE DENTAL PLLC

Practice address

8565 FM 2673
Canyon Lake, TX 78133-4908

Phone

(903) 360-8657

NPI assigned

Mar 3, 2020

Organization subpart

No

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

Authorized official

Name

Dhaval Thakkar

Title

Dentist/ Owner

Phone

(903) 360-8657

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1583193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583193600000",
    "number": "1447884176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9900 WESTPARK DR STE 350",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770635285",
            "telephone_number": "903-360-8657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8565 FM 2673",
            "city": "CANYON LAKE",
            "state": "TX",
            "postal_code": "781334908",
            "telephone_number": "903-360-8657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON LAKE DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-03",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A",
        "authorized_official_last_name": "THAKKAR",
        "authorized_official_first_name": "DHAVAL",
        "authorized_official_title_or_position": "DENTIST/ OWNER",
        "authorized_official_telephone_number": "903-360-8657"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Bumphus, PRSS
• Shawn Burch, LPC
• Eva Callahan
• Danny Lopez Campos, APRN, MSN, FNP-C
• Tammy Cantu, LPC
• Canyon Lake Family Dental Care, PLLC
• Canyon Lake Fire/EMS
• Canyon Lake Medical Clinic
• Canyon Lake Senior Home Care Inc. (Canyon Lake Senior Home Care)
• Camille Mari Coffey, LPC

• General Practice Dentistry in Canyon Lake, TX
• Providers in Canyon Lake, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2020; 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.