Organization
G FRIEND DDS MS & M WILSON DDS MS PA
Active
Other names
North Little Rock Pediatric Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK E WILSON DDS MS (CO OWNER)
(501) 771-2990
Entity
Organization
Contact information
Practice address
4605 FAIRWAY AVE, NORTH LITTLE ROCK, AR 72116
(501) 771-2990
(501) 758-0408
Mailing address
4605 FAIRWAY AVE, NORTH LITTLE ROCK, AR 72116
(501) 771-2990
(501) 753-0408
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
2700
AR
1223P0221X
Pediatric Dentistry
Primary
2793
AR
1223P0221X
Pediatric Dentistry
2817
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5B771
BCBS
AR
Enumeration date
07/25/2006
Last updated
08/22/2020
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