Provider Demographics
NPI:1306923065
Name:ARNOLD, FREDERICK W (DDS)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:W
Last Name:ARNOLD
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 1:541 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3423
Mailing Address - Country:US
Mailing Address - Phone:231-941-4090
Mailing Address - Fax:231-941-4048
Practice Address - Street 1:541 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3423
Practice Address - Country:US
Practice Address - Phone:231-941-4090
Practice Address - Fax:231-941-4048
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI098201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4058012Medicaid