Provider Demographics
NPI:1316016678
Name:DR. ARTHUR SONNEBORN DDS
Entity Type:Organization
Organization Name:DR. ARTHUR SONNEBORN DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:SONNEBORN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:517-787-9833
Mailing Address - Street 1:1415 W ARGYLE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-1978
Mailing Address - Country:US
Mailing Address - Phone:517-787-9833
Mailing Address - Fax:517-787-9350
Practice Address - Street 1:1415 W ARGYLE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-1978
Practice Address - Country:US
Practice Address - Phone:517-787-9833
Practice Address - Fax:517-787-9350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0143001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3375235Medicare ID - Type Unspecified