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General NPI Number Information
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NPI Number | 1467956425
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Entity Type | Organization
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Legal Business Name | GOLD CANYON CONTEMPORARY DENTISTRY
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Dates
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Enumeration Date | 03/22/2018
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Last Update Date | 03/22/2018
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Provider Practice Location Address
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Address Line | 6900 E. US HIGHWAY 60 STE. #110
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City | GOLD CANYON
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State | AZ
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Zip | 85118
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Country | US
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Telephone | 480-983-3444
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Fax |
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Provider Business Mailing Address
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Address Line | 6900 E. US HIGHWAY 60 STE. #110
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City | GOLD CANYON
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State | AZ
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Zip | 85118
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Country | US
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Telephone | 480-983-3444
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. MICHAEL S. GRAMS
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Credential | D.D.S.
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Telephone | 480-287-2793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7505
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License Number State | AZ
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