Provider Demographics
NPI:1750728747
Name:JAMES R. ARNESON, DDS,INC
Entity type:Organization
Organization Name:JAMES R. ARNESON, DDS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ARNESON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-486-3269
Mailing Address - Street 1:506 W MARINE WAY
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-7318
Mailing Address - Country:US
Mailing Address - Phone:907-486-3269
Mailing Address - Fax:907-486-3260
Practice Address - Street 1:506 W MARINE WAY
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-7318
Practice Address - Country:US
Practice Address - Phone:907-486-3269
Practice Address - Fax:907-486-3260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD07952Medicaid
AKDD40281Medicaid