Organization
RANDAL S. KIMBROUGH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARSHA KIMBROUGH (OFFICE MANAGER)
(479) 751-9899
Entity
Organization
Contact information
Practice address
2702 AMERICAN ST, SPRINGDALE, AR 72764-6937
(479) 751-9899
Mailing address
2702 AMERICAN ST, SPRINGDALE, AR 72764-6937
(479) 751-9899
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
177728608
—
AR
Enumeration date
07/31/2012
Last updated
07/31/2012
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