NPIMap

Organization Active NPI

G Friend DDS Ms & M Wilson DDS Ms PA

  • Pediatric Dentistry
  • North Little Rock, AR
National Provider Identifier
1508889478
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
2793 Issued in AR
Legal business name
G FRIEND DDS MS & M WILSON DDS MS PA
Practice address
4605 Fairway Ave
North Little Rock, AR 72116
Phone
(501) 771-2990
Fax
(501) 758-0408
NPI assigned
Jul 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mark E Wilson, DDS MSNPI 1912924424
Title
Co Owner
Phone
(501) 771-2990

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 2817 AR
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 2793 AR Primary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 2700 AR

Addresses

Primary practice location

4605 Fairway Ave
North Little Rock, AR 72116

Mailing address

4605 Fairway Ave
North Little Rock, AR 72116
Phone (501) 771-2990

Other identifiers 1

IdentifierTypeStateIssuer
5B771OtherARBCBS

Other names 1

  • North Little Rock Pediatric Dental Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Conway Pediatric Dental Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4605 Fairway Ave
North Little Rock, AR 72116
Phone (501) 771-2990

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508889478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4605 FAIRWAY AVE",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "72116",
            "telephone_number": "501-771-2990",
            "fax_number": "501-753-0408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4605 FAIRWAY AVE",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "72116",
            "telephone_number": "501-771-2990",
            "fax_number": "501-758-0408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G FRIEND DDS MS & M WILSON DDS MS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CO OWNER",
        "authorized_official_telephone_number": "501-771-2990",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS MS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AR",
            "license": "2817",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AR",
            "license": "2793",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AR",
            "license": "2700",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5B771",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Little Rock Pediatric Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.