Canyon Road Dental PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

CANYON ROAD DENTAL PLLC

Doing business as

Canyon Road Dental

Practice address

3707 N Canyon Rd Ste 2a
Provo, UT 84604-4525

Phone

(801) 997-6728

Fax

(385) 374-1555

NPI assigned

May 13, 2021

Last updated

May 13, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Faith Gaskins

Title

Director of Credentialing

Phone

(972) 869-3789

Specialties & licenses 1

Addresses

Other names 1

• Canyon Road Dental Doing business as

Locations

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

{
    "created_epoch": "1620864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620864000000",
    "number": "1700450905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3707 N CANYON RD STE 2A",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846044525",
            "telephone_number": "801-997-6728",
            "fax_number": "385-374-1555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3707 N CANYON RD STE 2A",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846044525",
            "telephone_number": "801-997-6728",
            "fax_number": "385-374-1555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON ROAD DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-13",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A",
        "authorized_official_last_name": "GASKINS",
        "authorized_official_first_name": "FAITH",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "972-869-3789"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyon Road Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Canyon Pharmaceutical, LLC (Rock Canyon Pharmacy)
• Canyon Ridge Psychology LLC
• Canyon River Dental
• Canyon River Dental
• Canyon River Dental
• Canyon View Medical Group LLC (Canyon View Womens Care Provo)
• Canyonview Family Practice
• Capable Now Therapy LLC
• Susan Capell
• Ethan Raymond Capria

• General Practice Dentistry in Provo, UT
• Providers in Provo, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2021; 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.