Healthcare Provider Details

I. General information

NPI: 1770526873
Provider Name (Legal Business Name): ARBUCKLE DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 S MAIN ST
CENTERVILLE UT
84014-2378
US

IV. Provider business mailing address

PO BOX 1088
CENTERVILLE UT
84014-5088
US

V. Phone/Fax

Practice location:
  • Phone: 801-292-0733
  • Fax: 801-298-5336
Mailing address:
  • Phone: 801-292-0733
  • Fax: 801-298-5336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. KENT KEVIN ARBUCKLE
Title or Position: PRESIDENT
Credential: DDS
Phone: 801-292-0733