Healthcare Provider Details

I. General information

NPI: 1669580163
Provider Name (Legal Business Name): ARTHUR F EVANS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 JACKSON SW GRAVETTE MERCY MEDICAL CLINIC BLDG
GRAVETTE AR
72736
US

IV. Provider business mailing address

PO BOX 186
GRANETTE AR
72736
US

V. Phone/Fax

Practice location:
  • Phone: 479-787-5256
  • Fax: 479-787-6950
Mailing address:
  • Phone: 479-787-5256
  • Fax: 479-787-6950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1952
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: