Organization
BRAD H. GREEN D.D.S., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRAD GREEN D.D.S. (OWNER)
(479) 445-7281
Entity
Organization
Contact information
Practice address
2421 N CENTER ST, SUITE D, FAYETTEVILLE, AR 72701-9455
(479) 445-6919
(479) 445-6929
Mailing address
101 S PITTMAN ST, PRAIRIE GROVE, AR 72753-3247
(479) 846-1005
(479) 846-1014
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3578
AR
Other
Enumeration date
02/05/2013
Last updated
02/05/2013
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