Healthcare Provider Details

I. General information

NPI: 1538229331
Provider Name (Legal Business Name): MICHAEL G ARVYSTAS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 WASHINGTON SQ N
NEW YORK NY
10011-9168
US

IV. Provider business mailing address

427 WASHINGTON ST
NEW YORK NY
10013-1735
US

V. Phone/Fax

Practice location:
  • Phone: 212-473-4444
  • Fax:
Mailing address:
  • Phone: 212-473-4444
  • Fax: 212-473-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number029098
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: