Look up the most recent NPI and PECOS records

Conway Dental Center Pllc

(<Unavail>)

Dentist

Dental Providers

1600 E. Oak Street Suite B, Conway, AR 72032

PECOS Enrollment

Based on the most recent information from CMS, provider Conway Dental Center Pllc does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1275035602
Provider Type
Organization
Full Name
Conway Dental Center Pllc
Other Name
<Unavail>

Subpart
No
Enumeration Date
3/1/2018
Last Updated
2/15/2019

Contact Information

Practice Location

1600 E. Oak Street Suite B, Conway, AR 72032

(501) 358-4489

Unlisted Fax

Mailing Location

PO Box 241785, Little Rock, AR 72223-0014

(501) 205-1084

Unlisted Fax

Authorized Official

Matone, Chad (Owner/Dentist)

(501) 205-1084

Provider Taxonomies

Code	Description	License
Code 1223G0001X Primary	Description Dentist Dental Providers	License 3574 Arkansas

Conway Dental Center Pllc

(<Unavail>)

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

Catholic Health Initiatives -St. Vincent Interfaith Clinic, Inc

Gordy, Spencer Preston

Weaver, Jennifer

Crafton, Leo

Simon, Greg J

Spencer Gordy Dds Pa

Summitt, James Alfred

Shahare, Alaa Mohammed

Jon C Vammen Dds

Conway Regional Medical Center, Inc