Provider Demographics
NPI: | 1891034674 |
---|---|
Name: | EDWARD WILSON ARNETTE, D.M.D.,P.C. |
Entity type: | Organization |
Organization Name: | EDWARD WILSON ARNETTE, D.M.D.,P.C. |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | EDWARD |
Authorized Official - Middle Name: | WILSON |
Authorized Official - Last Name: | ARNETTE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DMD |
Authorized Official - Phone: | 336-529-9308 |
Mailing Address - Street 1: | 505 BARNSDALE RIDGE RD |
Mailing Address - Street 2: | |
Mailing Address - City: | KERNERSVILLE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27284-7081 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 336-546-7373 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 509 N MAIN ST |
Practice Address - Street 2: | |
Practice Address - City: | KERNERSVILLE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27284-2645 |
Practice Address - Country: | US |
Practice Address - Phone: | 336-529-9308 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-02-13 |
Last Update Date: | 2013-02-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 8969 | 261QD0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QD0000X | Ambulatory Health Care Facilities | Clinic/Center | Dental |