Provider Demographics
NPI:1730360280
Name:ARZOLA, CARMEN DORIS (DDS)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:DORIS
Last Name:ARZOLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 METROPOLITAN AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-7443
Mailing Address - Country:US
Mailing Address - Phone:718-430-6996
Mailing Address - Fax:718-430-1793
Practice Address - Street 1:1414 METROPOLITAN AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-7443
Practice Address - Country:US
Practice Address - Phone:718-430-6996
Practice Address - Fax:718-430-1793
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0482621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01975002Medicaid