Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0004X | Dentist Anesthesiologist | D008161 | AZ |
N | 1223G0001X | General Practice | 057826-1 | NY |
N | 213EG0000X | General Practice | 057826-1 | NY |
Y | 1223G0001X | General Practice | D008161 | AZ |
Y | 213EG0000X | General Practice | D008161 | AZ |
N | 1223G0001X | General Practice | D4135 | ID |
N | 213EG0000X | General Practice | D4135 | ID |
NPI | 1255599700 |
---|---|
Provider Name | Dr. Matthew David Arnall |
First Address | Mesa, AZ 85207-2234 |
Second Address | Mesa, AZ 85207-2234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2008 |
Last Update Date | 10/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D008161 | ARIZONA STATE BOARD OF DENTAL EXAMINERS (01) | AZ |