Provider Demographics
NPI:1770822579
Name:CANYON FAMILY DENTAL, PLLC
Entity Type:Organization
Organization Name:CANYON FAMILY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-551-0228
Mailing Address - Street 1:2808 4TH AVE
Mailing Address - Street 2:B
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-4228
Mailing Address - Country:US
Mailing Address - Phone:806-557-4085
Mailing Address - Fax:806-557-4131
Practice Address - Street 1:2808 4TH AVE
Practice Address - Street 2:B
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-4228
Practice Address - Country:US
Practice Address - Phone:806-557-4085
Practice Address - Fax:806-557-4131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental