Healthcare Provider Details

I. General information

NPI: 1912250655
Provider Name (Legal Business Name): CENTRAL DENTAL - CONWAY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 PRINCE STREET
CONWAY AR
72034-3746
US

IV. Provider business mailing address

2415 PRINCE ST
CONWAY AR
72034-3746
US

V. Phone/Fax

Practice location:
  • Phone: 501-327-6453
  • Fax:
Mailing address:
  • Phone: 501-327-6453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. TODD C STEWART
Title or Position: OWNER
Credential: D.D.S.
Phone: 501-225-1577