Canyon Family Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

CANYON FAMILY DENTAL LLC

Practice address

500 N Estrella Pkwy Ste B1
Goodyear, AZ 85338-4136

Phone

(623) 880-0782

NPI assigned

Oct 3, 2019

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

Locations

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

{
    "created_epoch": "1570060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570060800000",
    "number": "1982245676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N ESTRELLA PKWY STE B1",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853384136",
            "telephone_number": "623-880-0782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N ESTRELLA PKWY STE B1",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853384136",
            "telephone_number": "623-880-0782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON FAMILY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-03",
        "last_updated": "2019-10-03",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Nicole Campbell
• Madeline Campbell, PT
• Nicole Francine Campbell, PT, DPT
• Savannah Canez
• Canyon Falls LLC
• Canyon Pain and Spine
• Canyon Trails Dental Care, PC
• Canyon Trails Family Dental, LLC
• Bernard P Capulong, MBA
• Jaden Capwell

• All providers in Goodyear, AZ
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; 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.