Provider Demographics
NPI:1215992854
Name:GONTY, ARTHUR A (DDS)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:A
Last Name:GONTY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2007
Mailing Address - Country:US
Mailing Address - Phone:859-236-1130
Mailing Address - Fax:859-239-9384
Practice Address - Street 1:400 S 4TH ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2007
Practice Address - Country:US
Practice Address - Phone:859-236-1130
Practice Address - Fax:859-239-9384
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4332174400000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60043320Medicaid
KY64043326Medicaid
KY64043326Medicaid
KY0201306Medicare ID - Type Unspecified