Healthcare Provider Details

I. General information

NPI: 1699065359
Provider Name (Legal Business Name): SENTHIL N ARUN BDS, DMD, MSD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2011
Last Update Date: 07/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N KEENE ST STE 208
COLUMBIA MO
65201-7193
US

IV. Provider business mailing address

303 N KEENE ST STE 208
COLUMBIA MO
65201-7193
US

V. Phone/Fax

Practice location:
  • Phone: 573-817-2222
  • Fax:
Mailing address:
  • Phone: 573-817-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2013009439
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: