Healthcare Provider Details

I. General information

NPI: 1356313134
Provider Name (Legal Business Name): ARNOLD GARY DELFINER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 6TH ST NAVAL HOSPITAL, DENTAL DIRECTORATE
GREAT LAKES IL
60088-2833
US

IV. Provider business mailing address

PO BOX 4242
ANTIOCH IL
60002-4242
US

V. Phone/Fax

Practice location:
  • Phone: 847-688-4560
  • Fax:
Mailing address:
  • Phone: 847-838-4804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number038905
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: