Provider Demographics
NPI:1295900553
Name:GARLAND COUNTY PEDIATRIC DENTISTRY PA
Entity type:Organization
Organization Name:GARLAND COUNTY PEDIATRIC DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MA
Authorized Official - Phone:501-224-4799
Mailing Address - Street 1:300 S RODNEY PARHAM RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4747
Mailing Address - Country:US
Mailing Address - Phone:501-224-4799
Mailing Address - Fax:501-224-9278
Practice Address - Street 1:600 MAIN ST
Practice Address - Street 2:SUITE X
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4905
Practice Address - Country:US
Practice Address - Phone:501-624-4421
Practice Address - Fax:501-624-6727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR18331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty