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General NPI Number Information
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NPI Number | 1194201145
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Entity Type | Individual
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Provider Name | THOMAS JOSEPH FREDERICK ARIETTA DMD
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Gender | Male
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 07/12/2018
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Provider Practice Location Address
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Address Line | 980 WILLOW CREEK RD STE 103
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City | PRESCOTT
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State | AZ
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Zip | 86301-1619
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Country | US
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Telephone | 928-460-5618
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Fax |
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Provider Business Mailing Address
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Address Line | 5700 MARKET ST APT 2029
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-6522
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10083
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License Number State | AZ
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