Provider Demographics
NPI:1881121457
Name:ARNOLD, JAY (DMD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6771 WEATHERED DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-2211
Mailing Address - Country:US
Mailing Address - Phone:541-922-7505
Mailing Address - Fax:
Practice Address - Street 1:1480 TIGER PARK LN
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563
Practice Address - Country:US
Practice Address - Phone:850-999-4672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22513122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist