Provider Demographics
NPI:1760648174
Name:JAMES L BEVANS PEDIATRIC DENTISTRY PA
Entity Type:Organization
Organization Name:JAMES L BEVANS PEDIATRIC DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BEVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-315-7800
Mailing Address - Street 1:7409 ALCOA ROAD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022
Mailing Address - Country:US
Mailing Address - Phone:501-315-7800
Mailing Address - Fax:
Practice Address - Street 1:7409 ALCOA ROAD
Practice Address - Street 2:SUITE 5
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022
Practice Address - Country:US
Practice Address - Phone:501-315-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR18331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty