Healthcare Provider Details

I. General information

NPI: 1407070451
Provider Name (Legal Business Name): JASON ARTHURS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8249 W THUNDERBIRD RD #110
PEORIA AZ
85381-4601
US

IV. Provider business mailing address

8249 W THUNDERBIRD RD #110
PEORIA AZ
85381-4601
US

V. Phone/Fax

Practice location:
  • Phone: 623-979-8800
  • Fax:
Mailing address:
  • Phone: 623-979-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5818
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: