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Organization
GREEN DENTAL LAB, INC.
Active
Organization
GREEN DENTAL LAB, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMBERLY THOMAS (LAB PRESIDENT)
(501) 362-3132
Entity
Organization
Contact information
Practice address
1099 WILBURN RD, HEBER SPRINGS, AR 72543-8905
(501) 362-3132
(501) 362-4717
Mailing address
1099 WILBURN RD, HEBER SPRINGS, AR 72543-8905
(501) 362-3132
(501) 362-4717
Taxonomy
Speciality
Code
Description
License number
State
292200000X
Dental Laboratory
Primary
123277-00
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
178993739
—
AR
Enumeration date
05/11/2016
Last updated
05/11/2016
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