Healthcare Provider Details

I. General information

NPI: 1437201373
Provider Name (Legal Business Name): PATRICK JAMES CANADAY DDS PC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 W PEORIA AVE 0 709
PHOENIX AZ
85029
US

IV. Provider business mailing address

3201 W PEORIA AVE 0 709
PHOENIX AZ
85029
US

V. Phone/Fax

Practice location:
  • Phone: 602-993-6783
  • Fax: 602-993-3303
Mailing address:
  • Phone: 602-993-6783
  • Fax: 602-993-3303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2327
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: