Healthcare Provider Details

I. General information

NPI: 1710448055
Provider Name (Legal Business Name): PHILLIP ARSUFFI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10309 MAIN ST
NEW MIDDLETOWN OH
44442-9717
US

IV. Provider business mailing address

761 GLENBROOK RD
YOUNGSTOWN OH
44512-2506
US

V. Phone/Fax

Practice location:
  • Phone: 330-542-9812
  • Fax:
Mailing address:
  • Phone: 330-503-0859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.026028
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: