NPIMap

Organization Active NPI

G Friend DDS Ms & M Wilson DDS Ms PA

Doing business as Conway Pediatric Dental Group

  • Pediatric Dentistry
  • Conway, AR
National Provider Identifier
1619960440
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
3475 Issued in AR
Legal business name
G FRIEND DDS MS & M WILSON DDS MS PA
Doing business as
Conway Pediatric Dental Group
Practice address
2700 Allyson Lane
Conway, AR 72034
Phone
(501) 730-0375
Fax
(501) 730-0335
NPI assigned
Aug 26, 2005
Last updated
Aug 22, 2020By the provider in NPPES
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. Gerald W Friend, DDS MSNPI 1811913999
Title
Owner
Phone
(501) 730-0375

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 2793 AR
Pediatric Dentistry 1223P0221X 3475 AR Primary
Pediatric Dentistry 1223P0221X 2817 AR

Addresses

Primary practice location

2700 Allyson Lane
Conway, AR 72034

Mailing address

PO Box 11020
Conway, AR 72034-0018
Phone (501) 730-0375

Other names 1

  • Conway 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

2700 Allyson Ln
Conway, AR 72034
Phone (501) 730-0375

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1125014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619960440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11020",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720340018",
            "telephone_number": "501-730-0375",
            "fax_number": "501-730-0335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 ALLYSON LANE",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "72034",
            "telephone_number": "501-730-0375",
            "fax_number": "501-730-0335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G FRIEND DDS MS & M WILSON DDS MS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FRIEND",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-730-0375",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS MS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AR",
            "license": "2793",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AR",
            "license": "3475",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AR",
            "license": "2817",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Conway Pediatric Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Conway, 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.