Provider Demographics
NPI:1639276603
Name:LAKEFRONT DENTAL PLLC
Entity type:Organization
Organization Name:LAKEFRONT DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-215-4913
Mailing Address - Street 1:5665 TIVOLI DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8241
Mailing Address - Country:US
Mailing Address - Phone:501-650-3717
Mailing Address - Fax:501-650-3717
Practice Address - Street 1:95 BEAVERFORK RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-9517
Practice Address - Country:US
Practice Address - Phone:501-327-6529
Practice Address - Fax:501-327-8695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR621710579OtherTAX ID