Healthcare Provider Details

I. General information

NPI: 1053325316
Provider Name (Legal Business Name): BORIANA CANBY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 N MAIN ST
EAST LONGMEADOW MA
01028-1838
US

IV. Provider business mailing address

42 GROVE AVE
LEEDS MA
01053-9721
US

V. Phone/Fax

Practice location:
  • Phone: 413-525-9500
  • Fax:
Mailing address:
  • Phone: 413-587-9981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21645
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: