Provider Demographics
NPI:1922108786
Name:WIDMAN, ARNOLD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:
Last Name:WIDMAN
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 1:902 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4531
Mailing Address - Country:US
Mailing Address - Phone:516-489-3050
Mailing Address - Fax:
Practice Address - Street 1:1900 HEMPSTEAD TURNPIKE
Practice Address - Street 2:SUITE 202
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554
Practice Address - Country:US
Practice Address - Phone:516-794-9211
Practice Address - Fax:516-794-9210
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0331031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00732710Medicaid