NPIMap

Organization Active NPI

Canyon Creek Family Dentistry, P.a.

  • General Practice Dentistry
  • Richardson, TX
National Provider Identifier
1659502730
Registry record updated Aug 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
20074 Issued in TX
Legal business name
CANYON CREEK FAMILY DENTISTRY, P.A.
Practice address
2091 N Collins Blvd Ste 100
Richardson, TX 75080-2636
Phone
(972) 644-3800
Fax
(972) 644-3888
NPI assigned
Aug 6, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2009

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

Authorized official

Name
Dr. Afshin Azmoodeh, D.D.S.NPI 1871699488
Title
President
Phone
(972) 644-3800

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 20074 TX Primary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 24260 TX

Addresses

Primary practice location

2091 N Collins Blvd Ste 100
Richardson, TX 75080-2636

Mailing address

2091 N Collins Blvd Ste 100
Richardson, TX 75080-2636
Phone (972) 644-3800

National Provider Directory

National Provider Directory

Locations

2091 N Collins Blvd
Ste 100
Richardson, TX 75080
Phone (972) 644-3800

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1249516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1249516800000",
    "number": "1659502730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2091 N COLLINS BLVD STE 100",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750802636",
            "telephone_number": "972-644-3800",
            "fax_number": "972-644-3888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2091 N COLLINS BLVD STE 100",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750802636",
            "telephone_number": "972-644-3800",
            "fax_number": "972-644-3888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON CREEK FAMILY DENTISTRY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-06",
        "last_updated": "2009-08-06",
        "status": "A",
        "authorized_official_last_name": "AZMOODEH",
        "authorized_official_first_name": "AFSHIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-644-3800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "20074",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "24260",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richardson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2009; 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.