Provider Demographics
NPI:1780797787
Name:MUND, ARTHUR JACKSON III (DDS)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:JACKSON
Last Name:MUND
Suffix:III
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 1:4620 CITYLAKE BLVD W
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3695
Mailing Address - Country:US
Mailing Address - Phone:817-263-0202
Mailing Address - Fax:817-927-7197
Practice Address - Street 1:4620 CITYLAKE BLVD W
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3695
Practice Address - Country:US
Practice Address - Phone:817-263-0202
Practice Address - Fax:817-927-7197
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122300000X122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX25DGOtherBCBS TX PROVIDER #
TX809903OtherUNITED CONCORDIA PROV #
TX84D742OtherBCBS PROVIDER #