Healthcare Provider Details

I. General information

NPI: 1013089242
Provider Name (Legal Business Name): ARNOLD AND WILSON DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 MARTIN LUTHER KING JR WAY
BERKELEY CA
94703-2151
US

IV. Provider business mailing address

2930 MARTIN LUTHER KING JR WAY
BERKELEY CA
94703-2151
US

V. Phone/Fax

Practice location:
  • Phone: 510-841-1128
  • Fax: 510-841-7920
Mailing address:
  • Phone: 510-841-1128
  • Fax: 510-841-7920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. WENDI L. WILSON
Title or Position: PRESIDENT ANDTREASURER
Credential: DDS
Phone: 510-841-1128