Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223X0400X | Orthodontists | 052775 | NY |
Y | 1223X0400X | Orthodontists | DN1855024 | MA |
NPI | 1033363155 |
---|---|
Provider Name | Dr. Michael David Caban |
First Address | Springfield, MA 01103-1077 |
Second Address | Springfield, MA 01103-1077 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2008 |
Last Update Date | 07/01/2009 |