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General NPI Number Information
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NPI Number | 1639064454
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Entity Type | Individual
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Provider Name | PAXTON ALEXANDER EVANS
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Gender | Male
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 104 S WALTON BLVD
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City | BENTONVILLE
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State | AR
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Zip | 72712-5747
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Country | US
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Telephone | 479-273-3757
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Fax |
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Provider Business Mailing Address
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Address Line | 3306 ASHEBURY PT
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City | GREENWOOD
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State | AR
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Zip | 72936-6841
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Country | US
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Telephone | 479-430-3677
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4851
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License Number State | AR
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