Provider Demographics
NPI:1467956425
Name:GOLD CANYON CONTEMPORARY DENTISTRY
Entity Type:Organization
Organization Name:GOLD CANYON CONTEMPORARY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-287-2793
Mailing Address - Street 1:6900 E. US HIGHWAY 60 STE. #110
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85118
Mailing Address - Country:US
Mailing Address - Phone:480-983-3444
Mailing Address - Fax:
Practice Address - Street 1:6900 E. US HIGHWAY 60 STE. #110
Practice Address - Street 2:
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85118
Practice Address - Country:US
Practice Address - Phone:480-983-3444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOLD CANYON CONTEMPORARY DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ75051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty