| Organization Name: | CANYON FAMILY DENTAL, PLLC |
| NPI Number: | 1770822579 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FRANKLIN ERNEST WEBER (PRESIDENT) |
| Mailing Address: | 2808 4th Ave B Canyon |
| State: | TX US |
| Postal Code: | 790154228 |
| Phone Number: | 8065574085 |
| Fax Number: | 8065574131 |
| NPI Enumeration Date: | 02/14/2013 |
| NPI Last Update Date: | 09/10/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |