Provider Demographics
NPI:1922498062
Name:BETHEL BURRIS OLIVER PLLC
Entity Type:Organization
Organization Name:BETHEL BURRIS OLIVER PLLC
Other - Org Name:ARKANSAS DENTISTRY AND BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-435-6335
Mailing Address - Street 1:3052 N MARKET AVE
Mailing Address - Street 2:APT 7
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3514
Mailing Address - Country:US
Mailing Address - Phone:479-435-6335
Mailing Address - Fax:479-301-2878
Practice Address - Street 1:3333 S PINNACLE HILLS PKWY
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-9100
Practice Address - Country:US
Practice Address - Phone:479-435-6335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR40131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty