Canyon River Dental

LBN: Canyon River Dental
Canyon River Dental is an health care organization with primary practice located at 3707 N Canyon Rd Suite 7D, Provo UT 84604. The organization recently has only one registered license in Dental Providers / Dentist, which is considered as the primary health care specialty. Canyon River Dental can be contacted via phone (801) 221-5859, or through Mangrum, Ryan T via phone (801) 221-5859.

Contact Information

Primary practice address
3707 N Canyon Rd Suite 7D Provo UT 84604
Phone: (801) 221-5859
Fax: (801) 221-7091
Website:
Map and Directions
Authorized official contact:
Name: Mangrum, Ryan T Doctor of Dental Medicine (DMD)
Phone: (801) 221-5859

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 3124349922 Utah

Profile Details

NPI number 1821196197
LBN Legal business name Canyon River Dental
DBA Doing business as
Authorized official Mangrum, Ryan T Doctor of Dental Medicine (DMD)
Entity Organization
Organization subpart 1 No
Enumeration date Sep 20th, 2006
Last updated Aug 22nd, 2020 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821196197 NPPES
Utah MEDICAID 529578391004

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