# GREEN COUNTRY DENTURE CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Premier Dentures & Implants
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215080734
- **Authorized official:** DR. JOHN LARD DDS (PRESIDENT)
- **Authorized official phone:** (918) 331-2221

## Contact information

- **Practice address:** 1824 S.E . WASHINGTON BLVD., BARTLESVILLE, OK 74006
- **Practice address phone:** (918) 331-2221
- **Practice address fax:** (918) 336-1052
- **Mailing address:** 1824 S.E . WASHINGTON BLVD., PO BOX 3248, BARTLESVILLE, OK 74006
- **Mailing address phone:** (918) 331-2221
- **Mailing address fax:** (918) 336-1052

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 5431 | OK | Yes |
| 122300000X | Dentist | 5779 | OK | — |

## Other

- **Enumeration date:** 01/19/2007
- **Last updated:** 06/26/2012