Organization Active NPI

Canon City Dental & Implants, PC

  • Dentist
  • Canon City, CO
National Provider Identifier
1639039621
Registry record updated Nov 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
CANON CITY DENTAL & IMPLANTS, PC
Practice address
1201 Royal Gorge Blvd
Canon City, CO 81212-3835
Phone
(719) 285-0241
Fax
(719) 285-0251
NPI assigned
Nov 13, 2025
Last updated
Nov 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2025

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

Authorized official

Name
Enjoli Guillory
Title
Director of RCM
Phone
(719) 464-0753

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

1201 Royal Gorge Blvd
Canon City, CO 81212-3835

Mailing address

2041 Pepper LN
Pueblo, CO 81005-3276
Phone (719) 285-0241

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1762992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762992000000",
    "number": "1639039621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2041 PEPPER LN",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810053276",
            "telephone_number": "719-285-0241",
            "fax_number": "719-285-0251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 ROYAL GORGE BLVD",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812123835",
            "telephone_number": "719-285-0241",
            "fax_number": "719-285-0251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANON CITY DENTAL & IMPLANTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-13",
        "last_updated": "2025-11-13",
        "certification_date": "2025-11-13",
        "status": "A",
        "authorized_official_last_name": "GUILLORY",
        "authorized_official_first_name": "ENJOLI",
        "authorized_official_title_or_position": "DIRECTOR OF RCM",
        "authorized_official_telephone_number": "719-464-0753"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canon City, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2025; 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.