Healthcare Provider Details

I. General information

NPI: 1255325247
Provider Name (Legal Business Name): LENA MARI ARVIDSON DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7781 HANSEN RD NE
BAINBRIDGE ISLAND WA
98110-1614
US

IV. Provider business mailing address

7781 HANSEN RD NE
BAINBRIDGE ISLAND WA
98110-1614
US

V. Phone/Fax

Practice location:
  • Phone: 206-823-8318
  • Fax:
Mailing address:
  • Phone: 206-823-8318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDE60534242
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: