Provider Demographics
NPI:1164076279
Name:GREEN DENTAL GROUP
Entity Type:Organization
Organization Name:GREEN DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARSHDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:SOHI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-440-1488
Mailing Address - Street 1:5808 BAY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-5210
Mailing Address - Country:US
Mailing Address - Phone:801-440-1488
Mailing Address - Fax:
Practice Address - Street 1:3020 LEGACY DR STE 210
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-8323
Practice Address - Country:US
Practice Address - Phone:801-440-1488
Practice Address - Fax:817-426-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty