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CANYON MODERN DENTISTRY
NPI 1194021170
Dentist - General Practice in Surprise, AZ

Active since February 08, 2011CLIA 03D2256776 · Waiver
17081 W GREENWAY RD STE 121, SURPRISE, AZ 85388(623) 546-8400(623) 214-5830 Get Directions Write a Review

NPPES record last updated: February 8, 2011. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Canyon Modern Dentistry NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CANYON MODERN DENTISTRY (NPI 1194021170) is a healthcare organization registered as a general practice in Surprise, Arizona and active in the NPI registry since February 2011. The organization holds a CLIA Waiver certificate valid through March 27, 2028 and lists James B Mallory, Owner Doctor, as its authorized official.

NPPES Registry Identity

NPI1194021170
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameCANYON MODERN DENTISTRY, LLP
Location Address17081 W GREENWAY RD STE 121Surprise, AZ 85388-9612
Mailing Address2860 Michelle Drive 2nd FloorIrvine, CA 92606 · (714) 368-2077 · Fax (714) 368-2092
Phone(623) 546-8400
Fax(623) 214-5830
Organization SubpartNo
Authorized OfficialJames B MalloryOwner Doctor · (623) 546-8400
Enumeration DateFebruary 8, 2011
✔ NPI 1194021170 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
Definition
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.
17081 W GREENWAY RD STE 121, Surprise, AZ 85388
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Other Names 1

Doing Business AsCanyon Modern Dentistry

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Humana.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 03D2256776

Canyon Modern Dentistry · Surprise, AZ
Active · expires Mar 27, 2028
CLIA Number03D2256776
Laboratory TypePractitioner Other
Certificate Effective DateMarch 28, 2026
Certificate Expiration DateMarch 27, 2028
Laboratory DirectorMohammed Khakwani
Laboratory Phone(623) 546-8400
Laboratory LocationCanyon Modern Dentistry17081 W Greenway Rd Ste 120, Surprise, AZ 85388
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Canyon Modern Dentistry, LLP's NPI number?

The NPI number for Canyon Modern Dentistry, LLP is 1194021170. It was assigned to this organization in the NPPES registry on February 8, 2011. The provider is doing business as Canyon Modern Dentistry.

Where is Canyon Modern Dentistry, LLP located?

Canyon Modern Dentistry, LLP is located at 17081 W Greenway Rd Ste 121, Surprise, AZ 85388. The listed phone number is (623) 546-8400.

What is Canyon Modern Dentistry, LLP's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Does Canyon Modern Dentistry, LLP hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 03D2256776) is associated with this NPI, valid through March 27, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Canyon Modern Dentistry, LLP accept?

Health plans from Ambetter from Arizona Complete Health and Humana list Canyon Modern Dentistry, LLP as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Canyon Modern Dentistry, LLP was last updated on February 8, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.