MEDICARE: DR. SUSAN ARNOLD DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	22DI101674700	NJ

General Provider Information

NPI Number	:	1598859563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN ARNOLD DMD

Provider Business Mailing Address
First Line	:	9 JODILEE LN
Second Line	:
City	:	RANDOLPH
State	:	NJ
Zip	:	07869-3125
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	390 STATE ROUTE 10
Second Line	:
City	:	RANDOLPH
State	:	NJ
Zip	:	07869-2141
Country	:	US
Telephone Number	:	973-989-7970
Fax Number	:	973-442-1711

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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