Provider Demographics
NPI: | 1760703441 |
---|---|
Name: | JESSE D. ARBON, DDS, MS, P.A. |
Entity type: | Organization |
Organization Name: | JESSE D. ARBON, DDS, MS, P.A. |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JESSE |
Authorized Official - Middle Name: | DONALD |
Authorized Official - Last Name: | ARBON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS, MS |
Authorized Official - Phone: | 801-913-6208 |
Mailing Address - Street 1: | 3047 REMINGTON OAKS CIR |
Mailing Address - Street 2: | |
Mailing Address - City: | CARY |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27519-8747 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 801-913-6208 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 10120 GREEN LEVEL CHURCH RD |
Practice Address - Street 2: | SUITE 212 |
Practice Address - City: | CARY |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27519-8141 |
Practice Address - Country: | US |
Practice Address - Phone: | 801-913-6208 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-06-17 |
Last Update Date: | 2010-06-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 8431 | 261QD0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QD0000X | Ambulatory Health Care Facilities | Clinic/Center | Dental |