Provider Demographics
NPI:1790833341
Name:ARBOGAST, AMY JO (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:JO
Last Name:ARBOGAST
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 E MOCKINGBIRD LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2145
Mailing Address - Country:US
Mailing Address - Phone:361-485-9607
Mailing Address - Fax:361-485-9613
Practice Address - Street 1:805 E MOCKINGBIRD LN
Practice Address - Street 2:SUITE A
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2145
Practice Address - Country:US
Practice Address - Phone:361-485-9607
Practice Address - Fax:361-485-9613
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX191591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB19159OtherCHIPS
TXD19159OtherBLUE CROSS