Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | D011167 | AZ |
NPI | 1215431416 |
---|---|
Provider Name | Carleigh Canterbury |
First Address | New York, NY 10016-8511 |
Second Address | Mesa, AZ 85206-3631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2018 |
Last Update Date | 25/01/2022 |