Provider Demographics
NPI:1316987431
Name:CONAWAY, FRANK L JR (DMD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:L
Last Name:CONAWAY
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 HANCOCK SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-1634
Mailing Address - Country:US
Mailing Address - Phone:228-467-4670
Mailing Address - Fax:
Practice Address - Street 1:292 HANCOCK SQUARE DR
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-1634
Practice Address - Country:US
Practice Address - Phone:228-467-4670
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2468891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSBC1974383OtherDEA #