Provider Demographics
NPI:1811913999
Name:FRIEND, GERALD WILLIAM (DDS MS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:WILLIAM
Last Name:FRIEND
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11020
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-0018
Mailing Address - Country:US
Mailing Address - Phone:501-730-0375
Mailing Address - Fax:
Practice Address - Street 1:2700 ALLYSON LANE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034
Practice Address - Country:US
Practice Address - Phone:501-730-0375
Practice Address - Fax:501-730-0335
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR27931223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58600OtherBLUE CROSS BLUE SHIELD
AR58600OtherBLUE CROSS BLUE SHIELD