Provider Demographics
NPI:1144088246
Name:PEVAHOUSE, ANN (DDS)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:PEVAHOUSE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 EDGEHILL RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-5443
Mailing Address - Country:US
Mailing Address - Phone:501-231-2947
Mailing Address - Fax:
Practice Address - Street 1:1202 HIGHWAY 35 N
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-2328
Practice Address - Country:US
Practice Address - Phone:501-776-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist