Healthcare Provider Details

I. General information

NPI: 1750728747
Provider Name (Legal Business Name): JAMES R. ARNESON, DDS,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 W MARINE WAY
KODIAK AK
99615-7318
US

IV. Provider business mailing address

506 W MARINE WAY
KODIAK AK
99615-7318
US

V. Phone/Fax

Practice location:
  • Phone: 907-486-3269
  • Fax: 907-486-3260
Mailing address:
  • Phone: 907-486-3269
  • Fax: 907-486-3260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name: JAMES ROBERT ARNESON
Title or Position: OWNER
Credential: DDS
Phone: 907-486-3269