| NPI | 1396408241 |
|---|---|
| Doing Business As | CANYON STATE DENTAL |
| Entity Type | Organization |
| Authorized Contact | FAITH GASKINS Director Of Credentialing 972-869-3789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2021-10-18 |
| Last Update Date | 2021-10-18 |