Healthcare Provider Details

I. General information

NPI: 1770495152
Provider Name (Legal Business Name): YORK CANYON DENTISTRY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 YORK CANYON RD
RATON NM
87740-2008
US

IV. Provider business mailing address

217 YORK CANYON RD 5756435982
RATON NM
87740-2008
US

V. Phone/Fax

Practice location:
  • Phone: 575-643-5982
  • Fax:
Mailing address:
  • Phone: 575-643-5982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TROY LEE WILSON
Title or Position: OWNER
Credential: DDS
Phone: 575-643-5982