Provider Demographics
NPI:1114104056
Name:ARTHUR S NOVELLY, DDS
Entity Type:Organization
Organization Name:ARTHUR S NOVELLY, DDS
Other - Org Name:ILANDS DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:NOVELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-892-6868
Mailing Address - Street 1:1520 W WARNER RD
Mailing Address - Street 2:#104
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-7066
Mailing Address - Country:US
Mailing Address - Phone:480-892-6868
Mailing Address - Fax:
Practice Address - Street 1:1520 W WARNER RD
Practice Address - Street 2:#104
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-7066
Practice Address - Country:US
Practice Address - Phone:480-892-6868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ3342261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental