NPIMap

Organization Active NPI

Bethel Burris Oliver PLLC

Doing business as Arkansas Dentistry and Braces

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Bentonville, AR
National Provider Identifier
1114260080
Registry record updated Mar 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
3465 Issued in AR
Legal business name
BETHEL BURRIS OLIVER PLLC
Doing business as
Arkansas Dentistry and Braces
Practice address
1400 SE Walton Blvd
Suite 42
Bentonville, AR 72712-3722
Phone
(479) 271-9944
Fax
(479) 271-9945
NPI assigned
Mar 29, 2013
Last updated
Mar 3, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Benjamin Burris, DDS, MDS, PA
Title
Owner
Phone
(479) 443-1705

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 3339 AR
Pediatric Dentistry 1223P0221X 3460 AR
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 4013 AR
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 3465 AR Primary

Addresses

Primary practice location

1400 SE Walton Blvd
Suite 42
Bentonville, AR 72712-3722

Mailing address

3782 N Front St
Suite 1
Fayetteville, AR 72703-5128
Phone (479) 443-1705

Other names 1

  • Arkansas Dentistry and Braces Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Arkansas Dentistry and Braces22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Locations

1400 SE Walton Blvd
Ste 42
Bentonville, AR 72712
Phone (479) 271-9944

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1364515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425340800000",
    "number": "1114260080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3782 N FRONT ST",
            "address_2": "SUITE 1",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035128",
            "telephone_number": "479-443-1705",
            "fax_number": "479-443-1586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 SE WALTON BLVD",
            "address_2": "SUITE 42",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123722",
            "telephone_number": "479-271-9944",
            "fax_number": "479-271-9945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHEL BURRIS OLIVER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-29",
        "last_updated": "2015-03-03",
        "status": "A",
        "authorized_official_last_name": "BURRIS",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-443-1705",
        "authorized_official_credential": "DDS, MDS, PA"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "3339",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AR",
            "license": "3460",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AR",
            "license": "4013",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "AR",
            "license": "3465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arkansas Dentistry and Braces",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bentonville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.