Provider Demographics
NPI:1518080613
Name:ARVIDSON, JAMES ROBERT (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:ARVIDSON
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:PO BOX B
Mailing Address - Street 2:
Mailing Address - City:MCGREGOR
Mailing Address - State:IA
Mailing Address - Zip Code:52157
Mailing Address - Country:US
Mailing Address - Phone:863-873-3780
Mailing Address - Fax:563-873-3780
Practice Address - Street 1:228 MAIN ST
Practice Address - Street 2:
Practice Address - City:MCGREGOR
Practice Address - State:IA
Practice Address - Zip Code:52157
Practice Address - Country:US
Practice Address - Phone:563-873-3780
Practice Address - Fax:563-873-3780
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06376122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0155358Medicaid