Provider Demographics
NPI:1205996683
Name:JEFFREY A ARNOLD, DDS, PC
Entity type:Organization
Organization Name:JEFFREY A ARNOLD, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-777-7780
Mailing Address - Street 1:4200 W PETERSON AVE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646
Mailing Address - Country:US
Mailing Address - Phone:773-777-7780
Mailing Address - Fax:847-564-2564
Practice Address - Street 1:4200 W PETERSON AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646
Practice Address - Country:US
Practice Address - Phone:773-777-7780
Practice Address - Fax:847-564-2564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty