Bethel Burris Oliver PLLC

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

4375 N Vantage Dr
Suite 202
Fayetteville, AR 72703-4982

Phone

(870) 972-8294

Fax

(870) 735-7853

NPI assigned

Jul 10, 2013

Last updated

May 4, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Benjamin G Burris, DDS, MDS

Title

Owner

Phone

(870) 972-8294

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Arkansas Dentistry and Braces Doing business as

Locations

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.

• Latoya Legrand Rolle, DDS

  • Pediatric Dentistry
  • Orlando, FL
  • NPI 1386097343
  NPD (past)

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

{
    "created_epoch": "1373414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430697600000",
    "number": "1487095139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 W BOND AVE",
            "city": "WEST MEMPHIS",
            "state": "AR",
            "postal_code": "723013909",
            "telephone_number": "870-972-8294",
            "fax_number": "870-735-7853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4375 N VANTAGE DR",
            "address_2": "SUITE 202",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034982",
            "telephone_number": "870-972-8294",
            "fax_number": "870-735-7853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHEL BURRIS OLIVER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-10",
        "last_updated": "2015-05-04",
        "status": "A",
        "authorized_official_last_name": "BURRIS",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-972-8294",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MDS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "AR",
            "license": "3465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "190787631",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arkansas Dentistry and Braces",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Leigh Ann Berry, CRNA
• Mary Amanda Bertalotto, RD, LD
• Bethel Burris Oliver PLLC (Arkansas Dentistry and Braces)
• Bethel Burris Oliver PLLC (Arkansas Dentistry and Braces)
• Bethel Burris Oliver PLLC (Sunshine Dental)
• Bethel Burris Oliver PLLC (Arkansas Dentistry and Braces)
• Bethel Burris Oliver PLLC (Arkansas Dentistry and Braces)
• Chad Lee Betts, M.D.
• Jillian Alicia Betts
• Gayathri Bhagwath, M.D.

• Orthodontics and Dentofacial Orthopedics Dentistry in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 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.