Organization
BETHEL BURRIS OLIVER PLLC
Active
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 (OWNER)
(870) 972-8294
Entity
Organization
Contact information
Practice address
4375 N VANTAGE DR, SUITE 202, FAYETTEVILLE, AR 72703-4982
(870) 972-8294
(870) 735-7853
Mailing address
126 W BOND AVE, WEST MEMPHIS, AR 72301-3909
(870) 972-8294
(870) 735-7853
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
3465
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190787631
—
AR
Enumeration date
07/10/2013
Last updated
05/04/2015
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