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General NPI Number Information
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NPI Number | 1619960440
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Entity Type | Organization
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Legal Business Name | G FRIEND DDS MS & M WILSON DDS MS PA
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2700 ALLYSON LANE
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City | CONWAY
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State | AR
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Zip | 72034
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Country | US
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Telephone | 501-730-0375
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Fax | 501-730-0335
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Provider Business Mailing Address
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Address Line | PO BOX 11020
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City | CONWAY
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State | AR
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Zip | 72034-0018
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Country | US
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Telephone | 501-730-0375
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Fax | 501-730-0335
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Authorized Official
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Title or Position | OWNER
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Name | DR. GERALD W FRIEND
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Credential | DDS MS
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Telephone | 501-730-0375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2793
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2817
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 3475
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License Number State | AR
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