Healthcare Provider Details

I. General information

NPI: 1750942983
Provider Name (Legal Business Name): ADRIAN CHARLES ARREOLA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 KNICKERBOCKER AVE
BROOKLYN NY
11237-3103
US

IV. Provider business mailing address

291 KNICKERBOCKER AVE
BROOKLYN NY
11237-3103
US

V. Phone/Fax

Practice location:
  • Phone: 484-554-4386
  • Fax:
Mailing address:
  • Phone: 484-554-4386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number06166201
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: