Provider Demographics
NPI:1477632255
Name:ARBUCKLE, ERIC L (DDS)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:L
Last Name:ARBUCKLE
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 1:4141 N HENDERSON RD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203
Mailing Address - Country:US
Mailing Address - Phone:703-243-9365
Mailing Address - Fax:703-525-9353
Practice Address - Street 1:4141 N HENDERSON RD
Practice Address - Street 2:SUITE 18
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203
Practice Address - Country:US
Practice Address - Phone:703-243-9365
Practice Address - Fax:703-525-9353
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410631122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1434005OtherUNITED CONCORDIA INS