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General NPI Number Information
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NPI Number | 1982123923
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Entity Type | Organization
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Legal Business Name | CANYON CREST DENTAL PC
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Dates
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Enumeration Date | 09/11/2017
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Last Update Date | 09/11/2017
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Provider Practice Location Address
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Address Line | 1899 W TRAVERSE PKWY STE B
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City | LEHI
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State | UT
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Zip | 84043-5995
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Country | US
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Telephone | 801-597-4570
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Fax |
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Provider Business Mailing Address
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Address Line | 1899 W TRAVERSE PKWY STE B
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City | LEHI
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State | UT
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Zip | 84043-5995
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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 | PRESIDENT
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Name | DR. GEOFFREY GRANT
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Credential | DDS
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Telephone | 801-597-4570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 9540983-9922
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License Number State | UT
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