CANYON TRAILS FAMILY DENTAL, LLC (NPI# 1104282425) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104282425 |
| Entity Type | Organization |
| Organization Name | CANYON TRAILS FAMILY DENTAL, LLC |
| Practice Address |
500 N Estrella Pkwy Suite B-1 Goodyear AZ 85338-4135 |
| Mailing Address |
4435 E Holmes Ave Suite #200 Mesa AZ 85206-3372 |
| Practice Telephone | 6238820782 |
| Practice Fax Number | 6238820878 |
| Mailing Telephone | 4808899457 |
| Mailing Fax Number | 4806965505 |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2016-01-04 |
| Authorized Official Name | JOHN E BALLARD (CFO, CIO) |
| Authorized Official Telephone | 4808899457 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
AZ | Dental Providers |
| Street Address |
500 N ESTRELLA PKWY SUITE B-1 |
| City | GOODYEAR |
| State | AZ |
| Zip Code | 85338-4135 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760404602 | Frederick Charles Buensuceso | Optometrist | 500 N Estrella Pkwy, Goodyear, AZ 85338-4135 | 2006-07-23 |
| 1427354422 | Ebcon Optics LLC | Optometrist | 500 N Estrella Pkwy, Goodyear, AZ 85338-4135 | 2011-02-08 |
| 1396977880 | Ashley Ann Heid | Dentist | 500 N Estrella Pkwy, Suite B-1, Goodyear, AZ 85338-4135 | 2009-08-17 |
| 1043356058 | Canyon Trails Dental Care, PC | Dentist | 500 N Estrella Pkwy, Suite B1, Goodyear, AZ 85338-4135 | 2007-01-29 |
| 1487714283 | Brent Richard Stanley | Dentist | 500 N Estrella Pkwy, Suite B-1, Goodyear, AZ 85338-4135 | 2006-12-11 |
| 1598825374 | Mark Delwyn Wheeler | Dentist | 500 N Estrella Pkwy, Suite B-1, Goodyear, AZ 85338-4135 | 2006-12-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295226884 | Caroline Chang | Dentist | 15530 W Roosevelt St Ste E106, Goodyear, AZ 85338 | 2018-05-20 |
| 1609376714 | Rosanna Alvarez | Licensed Practical Nurse | 17432 W Elaine Dr, Goodyear, AZ 85338 | 2018-02-15 |
| 1023534419 | Jennifer Elizabeth Lawrence Dixon | Social Worker | 319 N Lichfield Rd, Suite 105, Goodyear, AZ 85338 | 2017-08-17 |
| 1346774916 | Vanessa Castillo | Specialist/Technologist | 18035 W. Yuma Rd, Goodyear, AZ 85338 | 2017-04-20 |
| 1386008076 | Hope Behavioral Health Residential Care | Substance Abuse Rehabilitation Facility | 15985 W.williams Street, Goodyear, AZ 85338 | 2016-04-08 |
| 1952760241 | Jeremy John Abdul-haqq | Dentist | 15661 W Roosevelt St Ste 102, Goodyear, AZ 85338 | 2016-02-16 |
| 1417206897 | Kelly Renee Filo | Occupational Therapy Assistant | 10189 S. Hacienda Dr., Goodyear, AZ 85338 | 2012-08-31 |
| 1194015545 | Nancy Ann Amore | Licensed Practical Nurse | 15578 W Yuma Road, Goodyear, AZ 85338 | 2011-04-19 |
| 1932409208 | Chung Counihan | Pharmacist | 9890 S Estrella Parkway, Goodyear, AZ 85338 | 2010-11-02 |
| 1053611327 | Traven Anderson | Pharmacist | 9890 South Estrella Parkway, Goodyear, AZ 85338 | 2010-11-02 |
| Find all providers in zip 85338 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982245676 | Canyon Family Dental LLC | Dentist | 500 N Estrella Pkwy Ste B1, Goodyear, AZ 85338-4136 | 2019-10-03 |
| 1396222352 | Roopinder Singh Mann | Dentist | 14175 W Indian School Rd Ste B6, Goodyear, AZ 85395-8490 | 2018-07-23 |
| 1952760241 | Jeremy John Abdul-haqq | Dentist | 15661 W Roosevelt St Ste 102, Goodyear, AZ 85338 | 2016-02-16 |
| 1316256902 | Cory Gene Wooff | Dentist | 781 S Cotton Ln, Suite 100, Goodyear, AZ 85338-4643 | 2010-09-29 |
| 1164739736 | Josh Whatcott | Dentist | 105 N Litchfield Road, Goodyear, AZ 85338 | 2010-09-02 |
| 1447487632 | Dc Dental, LLC | Dentist | 15661 W. Roosevelt Street, Suite 102, Goodyear, AZ 85338 | 2009-06-16 |
| 1629220579 | Goodyear Smiles, LLP | Dentist | 781 South Cotton Lane, Suite 100, Goodyear, AZ 85338 | 2008-10-22 |
| 1700032158 | Daniel Wolter | Dentist | 14940 W Indian School Rd Ste 450, Goodyear, AZ 85395-7308 | 2008-08-15 |
| 1689876476 | Jose R. Gonzales. D.d.s. P.C. | Dentist | 3060 N. Litchfield Road, Suite 110, Goodyear, AZ 85338 | 2007-06-04 |
| 1366565384 | Daniel Wolter Dmd Ms PC | Dentist | 14940 W Indian School Road, Suite 450, Goodyear, AZ 85338 | 2007-04-06 |
| Find all providers in GOODYEAR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.