Provider Demographics
NPI:1740684562
Name:ARNOUK, MARIAM CLAIRE (RDH, DMD)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:CLAIRE
Last Name:ARNOUK
Suffix:
Gender:F
Credentials:RDH, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 SWIFTWATER WAY
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4607
Mailing Address - Country:US
Mailing Address - Phone:316-300-8959
Mailing Address - Fax:
Practice Address - Street 1:210 S GRAND AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4205
Practice Address - Country:US
Practice Address - Phone:316-300-8959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28679124Q00000X
CA103709122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No124Q00000XDental ProvidersDental Hygienist