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General NPI Number Information
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NPI Number | 1285057950
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Entity Type | Organization
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Legal Business Name | AMERICAN CANYON ORTHODONTICS
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Dates
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Enumeration Date | 01/30/2014
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Last Update Date | 01/30/2014
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Provider Practice Location Address
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Address Line | 3419 BROADWAY ST STE-H1
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City | AMERICAN CANYON
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State | CA
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Zip | 94503-1261
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Country | US
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Telephone | 707-651-9244
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Fax |
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Provider Business Mailing Address
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Address Line | 3419 BROADWAY ST STE-H1
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City | AMERICAN CANYON
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State | CA
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Zip | 94503-1261
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SARA MARKERT
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Credential | RDA
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Telephone | 707-651-9244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 60422
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License Number State | CA
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