MEDICARE: CANYON VIEW DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1790363752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANYON VIEW DENTAL

Provider Business Mailing Address
First Line	:	2412 PATTERSON RD STE 1
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1259
Country	:	US
Telephone Number	:	970-644-5272
Fax Number	:

Provider Business Practice Location Address
First Line	:	2412 PATTERSON RD STE 1
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1259
Country	:	US
Telephone Number	:	970-644-5272
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. KREHL STEGELMEIER
Credential	:	DDS
Telephone Number	:	970-778-2688

Provider Enumeration Date	:	03/31/2021
Last Update Date	:	03/31/2021

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Directions to “CANYON VIEW DENTAL ” Practice Location

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