Healthcare Provider Details

I. General information

NPI: 1083925663
Provider Name (Legal Business Name): ARIEL A ARZAMENDIA D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 112TH ST SW STE C2
EVERETT WA
98204-4875
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 425-249-0770
  • Fax: 425-249-0771
Mailing address:
  • Phone: 253-681-6626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60332158
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60332158
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: