Provider Demographics
NPI:1962677344
Name:DR. MICAH J. BEVINS D.D.S.
Entity Type:Organization
Organization Name:DR. MICAH J. BEVINS D.D.S.
Other - Org Name:BEVINS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:JON
Authorized Official - Last Name:BEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-252-4444
Mailing Address - Street 1:6349 S MEMORIAL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-1928
Mailing Address - Country:US
Mailing Address - Phone:918-252-4444
Mailing Address - Fax:918-252-4333
Practice Address - Street 1:6349 S MEMORIAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1928
Practice Address - Country:US
Practice Address - Phone:918-252-4444
Practice Address - Fax:918-252-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty