Healthcare Provider Details

I. General information

NPI: 1043228539
Provider Name (Legal Business Name): ARNOLD OEHRN KOON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 NORTH MAIN STREET
MASONTOWN PA
15461
US

IV. Provider business mailing address

546 NORTH MAIN STREET
MASONTOWN PA
15461
US

V. Phone/Fax

Practice location:
  • Phone: 724-583-8303
  • Fax: 724-583-8303
Mailing address:
  • Phone: 724-583-8303
  • Fax: 724-583-8303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number20025
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: