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General NPI Number Information
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NPI Number | 1740313394
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Entity Type | Organization
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Legal Business Name | ALPHA CANYON ENDODONTICS, PC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 875 N GREENFIELD RD SUITE 111
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City | GILBERT
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State | AZ
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Zip | 85234-5044
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Country | US
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Telephone | 480-558-1988
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Fax | 480-558-9188
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Provider Business Mailing Address
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Address Line | 875 N GREENFIELD RD SUITE 111
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City | GILBERT
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State | AZ
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Zip | 85234-5044
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Country | US
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Telephone | 480-558-1988
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Fax | 480-558-9188
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Authorized Official
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Title or Position | ENDODONTIST
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Name | DR. HUNG QUOC NGUYEN
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Credential | DDS
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Telephone | 480-558-1988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 4917
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License Number State | AZ
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