Individual
DR. ROBERT NELSON BEVILLE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4200 BRYANT IRVIN RD STE 129, BENBROOK, TX 76109-4212
(817) 569-6633
(817) 569-6636
Mailing address
2608 MUSEUM WAY APT 3513, FORT WORTH, TX 76107-3085
(806) 683-3382
(817) 569-6636
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
23986
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
193876301
—
TX
Enumeration date
06/25/2008
Last updated
10/16/2012
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