Individual
MRS. LEEYA PAN CARABALLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2445 ARTHUR AVE, BRONX, NY 10458-6003
(718) 365-3344
Mailing address
2445 ARTHUR AVE, BRONX, NY 10458-6003
(718) 365-3344
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
039223
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00893403
—
NY
Enumeration date
08/30/2006
Last updated
07/08/2007
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