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General NPI Number Information
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NPI Number | 1003777863
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Entity Type | Organization
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Legal Business Name | GB DENTAL PLLC
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Dates
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Enumeration Date | 11/20/2025
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 17 WILSON FARM RD
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City | GREENBRIER
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State | AR
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Zip | 72058-9310
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Country | US
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Telephone | 501-821-3133
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 241785
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City | LITTLE ROCK
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State | AR
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Zip | 72223-0014
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Country | US
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Telephone | 501-821-3133
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | CHAD D MATONE
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Credential | DDS
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Telephone | 501-821-3133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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