Provider Demographics
NPI:1144404005
Name:BANSEN, ARNOLD EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:EDWARD
Last Name:BANSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 METROPOLITAN PARKWAY
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-0000
Mailing Address - Country:US
Mailing Address - Phone:586-979-1450
Mailing Address - Fax:586-979-7891
Practice Address - Street 1:4515 METRO PARKWAY
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-0000
Practice Address - Country:US
Practice Address - Phone:586-979-1450
Practice Address - Fax:586-979-7891
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice