Provider Demographics
NPI:1356660682
Name:ARBOR DENTAL
Entity Type:Organization
Organization Name:ARBOR DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARANDAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-425-9090
Mailing Address - Street 1:1452 HUDSON ST
Mailing Address - Street 2:SUITE #200
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3066
Mailing Address - Country:US
Mailing Address - Phone:360-425-9090
Mailing Address - Fax:360-425-7323
Practice Address - Street 1:1452 HUDSON ST
Practice Address - Street 2:SUITE #200
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3066
Practice Address - Country:US
Practice Address - Phone:360-425-9090
Practice Address - Fax:360-425-7323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAD8959122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty