Provider Demographics
NPI:1467657668
Name:ARNOLD, EDWARD HENRY JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:HENRY
Last Name:ARNOLD
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 780
Mailing Address - Street 2:LODGE GRASS HEALTH CENTER-HARDING AVE.
Mailing Address - City:LODGE GRASS
Mailing Address - State:MT
Mailing Address - Zip Code:59050
Mailing Address - Country:US
Mailing Address - Phone:406-639-2317
Mailing Address - Fax:406-639-2976
Practice Address - Street 1:HARDING AVE
Practice Address - Street 2:LODGE GRASS HEALTH CENTER
Practice Address - City:LODGE GRASS
Practice Address - State:MT
Practice Address - Zip Code:59050
Practice Address - Country:US
Practice Address - Phone:406-639-2317
Practice Address - Fax:406-639-2976
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY#53651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice