| Doctor Name: | DR. ROBERT NELSON BEVILLE |
| NPI Number: | 1215199955 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DDS |
| License Number: | 23986 |
| Business Practice Address: | 4200 Bryant Irvin Rd Ste 129 Benbrook, TX - 761094212 |
| Business Phone Number: | 8175696633 |
| Business Fax Number: | 8175696636 |
| Mailing Address: | 2608 Museum Way Apt 3513, FORT WORTH |
| State: | TX |
| Postal Code: | 761073085 |
| Phone Number: | 8066833382 |
| Fax Number: | 8175696636 |
| NPI Enumeration Date: | 06/25/2008 |
| NPI Last Update Date: | 10/16/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0221X |
| License Number: | 23986 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Pediatric Dentistry |
| Taxonomy Definition: | 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. |