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
2606 BROWNS LANE, JONESBORO, AR 72401
(479) 445-6335
(479) 301-2878
Mailing address
3787 N. FRONT ST., SUITE 1, FAYETTEVILLE, AR 72703-5906
(479) 445-6335
(479) 301-2878
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
AR
1223P0221X
Pediatric Dentistry
—
AR
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
AR
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
3465
AR
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1740449339
—
AR
05
—
190787631
—
AR
05
—
206261631
—
AR
05
—
206304631
—
AR
Enumeration date
07/21/2011
Last updated
04/14/2015
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