Healthcare Provider Details

I. General information

NPI: 1922498062
Provider Name (Legal Business Name): BETHEL BURRIS OLIVER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 S PINNACLE HILLS PKWY
ROGERS AR
72758-9100
US

IV. Provider business mailing address

3052 N MARKET AVE APT 7
FAYETTEVILLE AR
72703-3514
US

V. Phone/Fax

Practice location:
  • Phone: 479-435-6335
  • Fax:
Mailing address:
  • Phone: 479-435-6335
  • Fax: 479-301-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4013
License Number StateAR

VIII. Authorized Official

Name: BENJAMIN BURRIS
Title or Position: OWNER
Credential:
Phone: 479-435-6335