BETHEL BURRIS OLIVER PLLC (NPI# 1700290194) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700290194 |
| Entity Type | Organization |
| Organization Name | BETHEL BURRIS OLIVER PLLC |
| Other Organization Name | ARKANSAS DENTISTRY AND BRACES |
| Practice Address |
4803 E Johnson Ave Jonesboro AR 72401-8413 |
| Mailing Address |
3782 N Front St Ste 1 Fayetteville AR 72703-5906 |
| Practice Telephone | 8702067835 |
| Practice Fax Number | 8702067837 |
| Mailing Telephone | 4794456335 |
| Mailing Fax Number | 4793012878 |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2015-03-04 |
| Authorized Official Name | DR. BENJAMIN G BURRIS (OWNER) |
| Authorized Official Telephone | 4794456335 |
| Authorized Official Credential | DDS, MDS, PA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
Dental Providers | ||
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers | ||
| N | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers | ||
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 206261631 | 05 | |
| AR | MEDICAID ORAL SURGERY | 206304680 | 01 |
| Other Name | Type Code |
|---|---|
| Arkansas Dentistry and Braces | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952772592 | Bethel Burris Oliver Pllc | Dentist | 4901 Warden Rd, North Little Rock, AR 72116-7013 | 2015-10-08 |
| 1952772584 | Bethel Burris Oliver Pllc | Dentist | 401 S Bowman Rd, Little Rock, AR 72211-3452 | 2015-10-08 |
| 1801267430 | Bethel Burris Oliver Pllc | Dentist | 4224 W Sunset Ave, Springdale, AR 72762-4806 | 2015-10-08 |
| 1982071510 | Bethel Burris Oliver Pllc | Dentist | 2906 Cypress Rd, Arkadelphia, AR 71923-4227 | 2015-08-31 |
| 1982081592 | Bethel Burris Oliver Pllc | Dentist | 3245 E. Race St, Searcy, AR 72143 | 2015-05-04 |
| 1942694351 | Bethel Burris Oliver Pllc | Dentist | 3500 West Black Forest Drive, Fayetteville, AR 72704-5906 | 2015-03-24 |
| 1922498062 | Bethel Burris Oliver Pllc | Dentist | 3333 S Pinnacle Hills Pkwy, Rogers, AR 72758-9100 | 2015-01-28 |
| 1386048189 | Bethel Burris Oliver Pllc | Dentist | 2901 Zion Rd, Fayetteville, AR 72703-5007 | 2014-10-22 |
| 1366883886 | Bethel Burris Oliver Pllc | Dentist | 3710 E Main St Ste J, Blytheville, AR 72315-6882 | 2013-07-12 |
| 1801237326 | Bethel Burris Oliver Pllc | Dentist | 4941 N Washington St, Forrest City, AR 72335-7723 | 2013-07-12 |
| Street Address |
4803 E JOHNSON AVE |
| City | JONESBORO |
| State | AR |
| Zip Code | 72401-8413 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407453368 | Mariah Kay Jackson | Physical Therapy Assistant | Creative Kids Therapy, Jonesboro, AR 72401 | 2020-10-05 |
| 1821606005 | Kafayat Folake Iyanda | Specialist/Technologist | 2105 East Aggie Rd, Jonesboro, AR 72401 | 2020-07-14 |
| 1053936310 | Josh Roberts | Physical Therapist | 1010 South Main St, Jonesboro, AR 72401 | 2020-06-12 |
| 1003449687 | Amy Mary Elizabeth Daughhetee | Nurse Practitioner | 225 East Washington Ave, Jonesboro, AR 72401 | 2020-02-21 |
| 1871126698 | Sarah Lowtharp | Clinical Nurse Specialist | 225 East Washington Ave., Jonesboro, AR 72401 | 2020-02-20 |
| 1891335519 | Mallori Miller | Case Manager/Care Coordinator | 837 Willett Rd, Jonesboro, AR 72401 | 2020-01-10 |
| 1265073704 | Michael Bruce Collie | Registered Nurse | 837 Williett Road, Jonesboro, AR 72401 | 2019-10-07 |
| 1285283432 | Jonesboro Ambulatory Surgery Center, LLC | Clinic/Center | 1710 Mayfield Dr, Jonesboro, AR 72401 | 2019-09-10 |
| 1841843943 | Destinee Katrina Cole | Specialist/Technologist | 2015 Aggie Rd, Jonesboro, AR 72401 | 2019-07-18 |
| 1699250472 | Jessica Marie Mcnatt | Occupational Therapist | 907 County Road 753, Jonesboro, AR 72401 | 2018-09-27 |
| Find all providers in zip 72401 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720242167 | Summer Barker Tyson | Dentist | 620 Southwest Dr, Jonesboro, AR 72401-5859 | 2008-07-15 |
| 1790909752 | Ken Wood, D.d.s. M.s. Childrens Dentistry | Dentist | 2702 S Culberhouse St, Suite Q, Jonesboro, AR 72401-7132 | 2007-04-12 |
| 1447310883 | Michael Douglas Oliver Jr. | Dentist | 809 Windover Rd, Jonesboro, AR 72401-6010 | 2006-12-08 |
| 1548360001 | Ken I Wood | Dentist | 2702 Culberhouse, Southwest Village, Jonesboro, AR 72401 | 2006-09-25 |
| 1164411674 | Dentistry for Children | Dentist | 435 Arrowhead Blvd, Jonesboro, GA 30236-1219 | 2005-10-18 |
| 1861937518 | Axpm Jonesboro Pedo, Pllc | Dentist | 1150 E Matthews Ave, Ste 102, Jonesboro, AR 72401-4346 | 2017-01-04 |
| 1225402373 | Homegrown Pediatric Dentistry and Orthodontics | Dentist | 405 Arrowhead Blvd, Jonesboro, GA 30236-1254 | 2015-11-30 |
| 1801181672 | Clemmisa Louise Harris | Dentist | 809 Windover Rd, Jonesboro, AR 72401-6010 | 2011-06-09 |
| 1538453006 | Tyson Dental Associates Pllc | Dentist | 620 Southwest Dr, Jonesboro, AR 72401-5859 | 2011-06-02 |
| 1689791519 | Angel M Guardiola | Dentist | 405 Arrowhead Blvd, Jonesboro, GA 30236-1254 | 2007-03-24 |
| Find all providers in JONESBORO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.