Provider Demographics
NPI:1992014435
Name:CANYON DENTAL CLINIC P.C.
Entity Type:Organization
Organization Name:CANYON DENTAL CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:IV
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-798-8496
Mailing Address - Street 1:665 E 300 S
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-2211
Mailing Address - Country:US
Mailing Address - Phone:801-798-8496
Mailing Address - Fax:801-798-1584
Practice Address - Street 1:665 E 300 S
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-2211
Practice Address - Country:US
Practice Address - Phone:801-798-8496
Practice Address - Fax:801-798-1584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1457091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty