Arthur F Evans, DDS

Individual provider Active NPI General Practice Dentistry · Gravette, AR

NPI 1669580163 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1669580163
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
1952 (AR)
Practice address
1102 Jackson SW
Gravette Mercy Medical Clinic BLDG
Gravette, AR 72736
Phone
(479) 787-5256
Fax
(479) 787-6950
NPI assigned
Aug 26, 2006
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
1952ARMDGeneral Practice Dentistry

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 1952 AR Yes

Addresses

Primary practice location

1102 Jackson SW
Gravette Mercy Medical Clinic BLDG
Gravette, AR 72736

Mailing address

PO Box 186
Granette, AR 72736
Phone (479) 787-5256

Other identifiers

IdentifierTypeStateIssuer
108957OtherUNITED CONCORDIA
58161OtherBCBS

Other providers in Gravette, AR

All providers in Gravette, AR · General Practice Dentistry in Arkansas

Sources for this page

Verify at the official NPI Registry.