Healthcare Provider Details

I. General information

NPI: 1316016678
Provider Name (Legal Business Name): DR. ARTHUR SONNEBORN DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1415 W ARGYLE ST
JACKSON MI
49202-1978
US

IV. Provider business mailing address

1415 W ARGYLE ST
JACKSON MI
49202-1978
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-9833
  • Fax: 517-787-9350
Mailing address:
  • Phone: 517-787-9833
  • Fax: 517-787-9350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number014300
License Number StateMI

VIII. Authorized Official

Name: ARTHUR AARON SONNEBORN
Title or Position: OWNER
Credential: D.D.S., M.S.
Phone: 517-787-9833