Provider Demographics
NPI:1215199955
Name:BEVILLE, ROBERT NELSON III (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NELSON
Last Name:BEVILLE
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2608 MUSEUM WAY APT 3513
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3085
Mailing Address - Country:US
Mailing Address - Phone:806-683-3382
Mailing Address - Fax:817-569-6636
Practice Address - Street 1:4200 BRYANT IRVIN RD STE 129
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76109-4212
Practice Address - Country:US
Practice Address - Phone:817-569-6633
Practice Address - Fax:817-569-6636
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX239861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193876301Medicaid