=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760703441
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JESSE D. ARBON, DDS, MS, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2010
-----------------------------------------------------
Last Update Date | 06/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10120 GREEN LEVEL CHURCH RD SUITE 212
-----------------------------------------------------
City | CARY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27519-8141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-913-6208
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3047 REMINGTON OAKS CIR
-----------------------------------------------------
City | CARY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27519-8747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-913-6208
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JESSE DONALD ARBON
-----------------------------------------------------
Credential | DDS, MS
-----------------------------------------------------
Telephone | 801-913-6208
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 8431
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------