Healthcare Provider Details

I. General information

NPI: 1275654808
Provider Name (Legal Business Name): CVD CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

Provider Other Name: CANYON VISTA DENTAL CARE

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S IDAHO RD STE 260
APACHE JUNCTION AZ
85119-2379
US

IV. Provider business mailing address

110 S IDAHO RD STE 260
APACHE JUNCTION AZ
85119-2379
US

V. Phone/Fax

Practice location:
  • Phone: 480-982-0782
  • Fax:
Mailing address:
  • Phone: 480-982-0782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice
License NumberD2561
License Number StateAZ

VIII. Authorized Official

Name: DR. JOHN ARTHUR BIGLER
Title or Position: DOCTOR
Credential: D.D.S.
Phone: 480-982-0782