Provider Demographics
NPI:1861605289
Name:DORNBERG, ARNOLD M (DDS)
Entity type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:M
Last Name:DORNBERG
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 1:70 ASH DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2206
Mailing Address - Country:US
Mailing Address - Phone:516-484-8331
Mailing Address - Fax:
Practice Address - Street 1:6134 188TH ST
Practice Address - Street 2:SUITE 212
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2726
Practice Address - Country:US
Practice Address - Phone:718-454-8666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036437122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist