Provider Demographics
NPI:1801840749
Name:WAH, ARLENE JADE (DDS)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:JADE
Last Name:WAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ARLENE
Other - Middle Name:JADE
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:122 BLOCK ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-1956
Mailing Address - Country:US
Mailing Address - Phone:870-739-4076
Mailing Address - Fax:
Practice Address - Street 1:122 BLOCK ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-1956
Practice Address - Country:US
Practice Address - Phone:870-739-4076
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2950122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58813OtherBLUE CROSS BLUE SHIELD
551823OtherUNITED CONCORDIA