Healthcare Provider Details

I. General information

NPI: 1740684562
Provider Name (Legal Business Name): MARIAM CLAIRE ARNOUK RDH, DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S GRAND AVE SUITE 420
GLENDORA CA
91741-4205
US

IV. Provider business mailing address

2206 SWIFTWATER WAY
GLENDORA CA
91741-4607
US

V. Phone/Fax

Practice location:
  • Phone: 316-300-8959
  • Fax:
Mailing address:
  • Phone: 316-300-8959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number103709
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number28679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: