Provider Demographics
NPI:1730904004
Name:CANYON RIM DENTAL - HEBER LLC
Entity type:Organization
Organization Name:CANYON RIM DENTAL - HEBER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-228-5446
Mailing Address - Street 1:3387 SAWMILL POINTE RD STE B
Mailing Address - Street 2:
Mailing Address - City:HEBER
Mailing Address - State:AZ
Mailing Address - Zip Code:85928-6002
Mailing Address - Country:US
Mailing Address - Phone:928-228-5446
Mailing Address - Fax:928-228-5456
Practice Address - Street 1:3387 SAWMILL POINTE RD STE B
Practice Address - Street 2:
Practice Address - City:HEBER
Practice Address - State:AZ
Practice Address - Zip Code:85928-6002
Practice Address - Country:US
Practice Address - Phone:928-228-5446
Practice Address - Fax:928-228-5456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental