Healthcare Provider Details

I. General information

NPI: 1104751742
Provider Name (Legal Business Name): CANYON RANCH DENTAL CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W AMERICAN CANYON RD STE M8
AMERICAN CANYON CA
94503-1181
US

IV. Provider business mailing address

120 W AMERICAN CANYON RD STE M8
AMERICAN CANYON CA
94503-1181
US

V. Phone/Fax

Practice location:
  • Phone: 707-557-9080
  • Fax:
Mailing address:
  • Phone: 707-557-9080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: JOANNE RIVERA
Title or Position: DENTIST
Credential: DDS
Phone: 408-656-4567