CANYON MODERN DENTISTRY
NPI 1194021170
Dentist - General Practice in Surprise, AZ
NPI Status: Active since February 08, 2011
Contact Information
17081 W GREENWAY RD STE 121
SURPRISE, AZ
ZIP 85388
Phone: (623) 546-8400
Fax: (623) 214-5830
- Organization
- Dentist
- General Practice
- Accepts Insurance
- CLIA Number: 03D2256776
- CLIA Cert. Type: Practitioner Other
- CLIA Exp. Date: 03-27-2028
About CANYON MODERN DENTISTRY
This page provides the complete NPI Profile along with additional information for Canyon Modern Dentistry, a provider established in Surprise, Arizona operating as a Dentist, focusing in general practice . The healthcare provider is registered in the NPI registry with number 1194021170 assigned on February 2011. The practitioner's primary taxonomy code is 1223G0001X. The provider is registered as an organization and their NPI record was last updated 15 years ago. Canyon Modern Dentistry operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The provider's is doing business as Canyon Modern Dentistry. The authorized official of this NPI record is Dr. James B Mallory Jr. Dmd (Owner Doctor)
- NPI
- 1194021170
- Provider Legal Name
- CANYON MODERN DENTISTRY, LLP
- Other Organization Name
- CANYON MODERN DENTISTRY
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 17081 W GREENWAY RD STE 121 SURPRISE, AZ 85388
- Location Phone
- (623) 546-8400
- Location Fax
- (623) 214-5830
- Mailing Address
- 2860 MICHELLE DRIVE 2ND FLOOR IRVINE, CA 92606
- Mailing Phone
- (714) 368-2077
- Mailing Fax
- (623) 214-5830
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 02-08-2011
- Last Update Date
- 02-08-2011
- Code Navigator
A dentist like Canyon Modern Dentistry is a skilled in and licensed provider that diagnoses and treats problems with patients teeth, gums, and related parts of the mouth. Dentists educate patients on how to take care of the teeth and gums and provide information on diet choices that affect oral health. Dentists must be licensed in the state in which they work.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Dentist General Practice
- Taxonomy Code
- 1223G0001X
- Type
- Dental Providers
- Taxonomy Description
- A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Choice Bronze HSA - HMO
- Choice Bronze HSA + Vision + Adult Dental - HMO
- Complete Gold - HMO
- Complete Gold + Vision + Adult Dental - HMO
- Complete Silver - HMO
- Complete Silver + Vision + Adult Dental - HMO
- Elite Gold - HMO
- Elite Gold + Vision + Adult Dental - HMO
- Everyday Bronze - HMO
- Everyday Bronze + Vision + Adult Dental - HMO
- Standard Expanded Bronze - HMO
- Standard Expanded Bronze + Vision + Adult Dental - HMO
- Standard Gold - HMO
- Standard Gold + Vision + Adult Dental - HMO
- Standard Silver - HMO
- Standard Silver + Vision + Adult Dental - HMO
- Humana Dental Smart Choice - PPO
- Humana Dental Smart Choice - Basic - PPO
- Humana Dental Smart Choice - High - PPO
- Humana Dental Smart Choice - Lite - PPO
- Humana Dental Smart Choice - Low - PPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 03D2256776
- Facility Type
- Practitioner Other
- Certificate Effective Date
- March 28, 2026
- Certificate Expiration Date
- March 27, 2028
- Laboratory Director
- MOHAMMED KHAKWANI
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Canyon Modern Dentistry to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1194021170, we treat the final digit (0) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 50. The final step is to find the difference between that total and the next multiple of ten (50 - 50 = 0).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 50 is 50. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1194021170, enumerated as an "organization" on February 08, 2011.
The provider is located at 17081 W GREENWAY RD STE 121 SURPRISE, AZ 85388 and the phone number is (623) 546-8400.
Dentist with taxonomy code 1223G0001X and a focus in General Practice.
The provider might be accepting Accepts: Ambetter from Arizona Complete Health and Humana. Please consult your insurance carrier or call the provider to verify.
