Provider Demographics
NPI:1720073703
Name:ARQUITT, GEORGE E III (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:E
Last Name:ARQUITT
Suffix:III
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 E MONTCLAIR ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5076
Mailing Address - Country:US
Mailing Address - Phone:417-887-8800
Mailing Address - Fax:417-887-6265
Practice Address - Street 1:1103 E MONTCLAIR ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5076
Practice Address - Country:US
Practice Address - Phone:417-887-8800
Practice Address - Fax:417-887-6265
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002002703D1223S0112X
MO2002001969M1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2703OtherDELTA DENTAL
MO157751OtherBC/S MEDICAL
MO157751OtherBLUE CHOICE
MO190010364OtherRR MEDICARE
MO12278OtherBC/S DENTAL
MO405747700Medicaid
MO12278OtherBC/S DENTAL