Provider Demographics
NPI:1699785923
Name:BEVANS CHILDREN'S DENTISTRY, P.A.
Entity type:Organization
Organization Name:BEVANS CHILDREN'S DENTISTRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:501-224-4799
Mailing Address - Street 1:300 S RODNEY PARHAM RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4747
Mailing Address - Country:US
Mailing Address - Phone:501-224-4799
Mailing Address - Fax:501-224-9278
Practice Address - Street 1:300 S RODNEY PARHAM RD
Practice Address - Street 2:SUITE 3
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4747
Practice Address - Country:US
Practice Address - Phone:501-224-4799
Practice Address - Fax:501-224-9278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR35421223G0001X
AR35551223G0001X
AR18331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR=========OtherTAX ID NUMBER