=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891034674
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDWARD WILSON ARNETTE, D.M.D.,P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2013
-----------------------------------------------------
Last Update Date | 02/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 509 N MAIN ST
-----------------------------------------------------
City | KERNERSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27284-2645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-529-9308
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 505 BARNSDALE RIDGE RD
-----------------------------------------------------
City | KERNERSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27284-7081
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-546-7373
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. EDWARD WILSON ARNETTE
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 336-529-9308
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 8969
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------