Individual ProviderLuke FrucheyDentistDental ProvidersPractice Address1125 S Amity Rd, Conway, AR 72032-8090(501) 557-3085PECOS EnrollmentBased on the most recent information from CMS, provider Luke Fruchey does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:47 AM.Profile DetailsProvider ID1497310288Provider TypeIndividualFull NameFruchey, LukeGenderMaleSole ProprietorNoEnumeration Date5/7/2019Last Updated6/17/2019Contact InformationPractice LocationPractice Address1125 S Amity Rd, Conway, AR 72032-8090Phone(501) 557-3085FaxUnlisted FaxMailing LocationMailing Address4120 Zachary Trl, Conway, AR 72034-8212PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1223G0001XPrimaryDescriptionDentistDental ProvidersLicense4364ArkansasCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer