Provider Demographics
NPI:1528136983
Name:ARNOLD, PETER BRUCE (DDS)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:BRUCE
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 1:91 WEST GENEVA ST., PO BOX 780
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILLIAMS BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53191
Mailing Address - Country:US
Mailing Address - Phone:262-245-6763
Mailing Address - Fax:
Practice Address - Street 1:91 WEST GENEVA ST.
Practice Address - Street 2:SUITE 1
Practice Address - City:WILLIAMS BAY
Practice Address - State:WI
Practice Address - Zip Code:53191
Practice Address - Country:US
Practice Address - Phone:262-245-6763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5000595-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice