Provider Demographics
NPI:1174713242
Name:NOVELLY, ARTHUR S (DDS)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:S
Last Name:NOVELLY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ARTHUR
Other - Middle Name:
Other - Last Name:NOVELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1520 W WARNER RD
Mailing Address - Street 2:#104
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-7066
Mailing Address - Country:US
Mailing Address - Phone:480-892-6868
Mailing Address - Fax:
Practice Address - Street 1:1520 W WARNER RD
Practice Address - Street 2:#104
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-7066
Practice Address - Country:US
Practice Address - Phone:480-892-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3342122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist