Organization
BETHEL BURRIS OLIVER PLLC
Active
Other names
Arkansas Dentistry and Braces
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN G BURRIS DDS, MDS, PA (OWNER)
(479) 445-6335
Entity
Organization
Contact information
Practice address
1310 S ROCK ST, SUITE 1, SHERIDAN, AR 72150-7160
(870) 942-4444
(870) 942-4454
Mailing address
3782 N FRONT ST STE 1, FAYETTEVILLE, AR 72703-5906
(479) 445-6335
(479) 301-2878
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
206265631
—
AR
01
—
206307680
ORAL SURGERY MEDICAID
AR
Enumeration date
06/22/2010
Last updated
03/04/2015
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