Provider Demographics
NPI:1790144996
Name:CANYON CREEK FAMILY DENTISTRY PLANO, PLLC
Entity Type:Organization
Organization Name:CANYON CREEK FAMILY DENTISTRY PLANO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AFSHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AZMOODEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-644-3800
Mailing Address - Street 1:7224 INDEPENDENCE PKWY
Mailing Address - Street 2:SUITE # 312
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-5759
Mailing Address - Country:US
Mailing Address - Phone:972-312-1718
Mailing Address - Fax:
Practice Address - Street 1:7224 INDEPENDENCE PKWY
Practice Address - Street 2:SUITE # 312
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-5759
Practice Address - Country:US
Practice Address - Phone:972-312-1718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANYON CREEK FAMILY DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty