Organization
BRAD H GREEN DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRAD GREEN DDS (PRESIDENT)
(479) 846-1005
Entity
Organization
Contact information
Practice address
401 E BUCHANAN, PRAIRIE GROVE, AR 72753
(479) 846-1005
Mailing address
101 S PITTMAN ST, PO BOX 288, PRAIRIE GROVE, AR 72753-3247
(479) 846-1005
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3578
AR
Other
Enumeration date
09/28/2007
Last updated
05/02/2008
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