Provider Demographics
NPI:1588984843
Name:KIMBROUGH, RANDAL SHEPARD (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:SHEPARD
Last Name:KIMBROUGH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 AMERICAN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-6937
Mailing Address - Country:US
Mailing Address - Phone:479-751-9899
Mailing Address - Fax:479-751-8705
Practice Address - Street 1:2702 AMERICAN ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-6937
Practice Address - Country:US
Practice Address - Phone:479-751-9899
Practice Address - Fax:479-751-8705
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1063826081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice