Organization Active NPI

Lakefront Dental PLLC

  • General Practice Dentistry
  • Conway, AR
National Provider Identifier
1639276603
Registry record updated Mar 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LAKEFRONT DENTAL PLLC
Practice address
95 Beaverfork Rd
Conway, AR 72032-9517
Phone
(501) 327-6529
Fax
(501) 327-8695
NPI assigned
Sep 20, 2006
Last updated
Mar 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2025

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

Authorized official

Name
Stuart SherwoodNPI 1669854493
Title
Dentist Owner
Phone
(501) 215-4913

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

95 Beaverfork Rd
Conway, AR 72032-9517

Mailing address

5665 Tivoli Dr
Conway, AR 72034-8241
Phone (501) 650-3717

Other identifiers 1

IdentifierTypeStateIssuer
621710579OtherARTAX ID

National Provider Directory

National Provider Directory

Locations

95 Beaverfork Rd
Conway, AR 72032
Phone (501) 327-6529

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": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741651200000",
    "number": "1639276603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5665 TIVOLI DR",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720348241",
            "telephone_number": "501-650-3717",
            "fax_number": "501-650-3717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 BEAVERFORK RD",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720329517",
            "telephone_number": "501-327-6529",
            "fax_number": "501-327-8695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEFRONT DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2025-03-11",
        "certification_date": "2025-03-11",
        "status": "A",
        "authorized_official_last_name": "SHERWOOD",
        "authorized_official_first_name": "STUART",
        "authorized_official_title_or_position": "DENTIST OWNER",
        "authorized_official_telephone_number": "501-215-4913"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "621710579",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Mar 11, 2025; 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.