Healthcare Provider Details

I. General information

NPI: 1801267430
Provider Name (Legal Business Name): BETHEL BURRIS OLIVER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 W SUNSET AVE
SPRINGDALE AR
72762-4806
US

IV. Provider business mailing address

4375 N VANTAGE DR SUITE 202
FAYETTEVILLE AR
72703-4982
US

V. Phone/Fax

Practice location:
  • Phone: 479-445-6335
  • Fax: 479-301-2878
Mailing address:
  • Phone: 479-445-6335
  • Fax: 479-301-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BENJAMIN BURRIS
Title or Position: OWNER
Credential: DDS, MDS
Phone: 479-445-6335