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General NPI Number Information
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NPI Number | 1639276603
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Entity Type | Organization
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Legal Business Name | LAKEFRONT DENTAL PLLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 95 BEAVERFORK RD
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City | CONWAY
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State | AR
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Zip | 72032-9517
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Country | US
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Telephone | 501-327-6529
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Fax | 501-327-8695
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Provider Business Mailing Address
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Address Line | 5665 TIVOLI DR
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City | CONWAY
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State | AR
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Zip | 72034-8241
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Country | US
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Telephone | 501-650-3717
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Fax | 501-650-3717
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | STUART SHERWOOD
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Credential |
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Telephone | 501-215-4913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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