Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 7838 | AZ |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D07838 | AZ |
N | 1223X2210X | Orofacial Pain | D07838 | AZ |
NPI | 1043541907 |
---|---|
Provider Name | Dr. Jeffrey Craig Wight |
First Address | Phoenix, AZ 85028-4243 |
Second Address | Phoenix, AZ 85028-4243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2010 |
Last Update Date | 05/10/2021 |