Provider Demographics
NPI:1952361339
Name:ARLICK, JAY L (DMD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:L
Last Name:ARLICK
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 1:109 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830
Mailing Address - Country:US
Mailing Address - Phone:814-765-3533
Mailing Address - Fax:
Practice Address - Street 1:109 N FRONT ST
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830
Practice Address - Country:US
Practice Address - Phone:814-765-3533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026572L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
178506OtherBLUE SHIELD
PA1014240750001Medicaid
T84851Medicare UPIN
PA1014240750001Medicaid