Provider Demographics
NPI:1144775230
Name:CANYON POINT IMPLANT & ORAL SURGERY
Entity type:Organization
Organization Name:CANYON POINT IMPLANT & ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MADLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD
Authorized Official - Phone:303-215-9944
Mailing Address - Street 1:108 N RUBEY DR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-2455
Mailing Address - Country:US
Mailing Address - Phone:303-215-9944
Mailing Address - Fax:303-215-9947
Practice Address - Street 1:108 N RUBEY DR
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-2455
Practice Address - Country:US
Practice Address - Phone:303-215-9944
Practice Address - Fax:303-215-9947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.000094861223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty