MEDICARE: PRECIDENT FLORIDA PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223P0300X	Periodontics
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609464205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECIDENT FLORIDA PLLC

Provider Business Mailing Address
First Line	:	PO BOX 2523
Second Line	:	DEPT 4316
City	:	CONWAY
State	:	AR
Zip	:	72033-2523
Country	:	US
Telephone Number	:	727-397-8503
Fax Number	:	727-397-2679

Provider Business Practice Location Address
First Line	:	390 4TH ST N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33701-2802
Country	:	US
Telephone Number	:	727-397-8503
Fax Number	:	727-398-2679

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SCOTT L BOLDING
Credential	:	DDS MS
Telephone Number	:	479-957-4611

Provider Enumeration Date	:	01/08/2021
Last Update Date	:	06/07/2022

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Directions to “PRECIDENT FLORIDA PLLC ” Practice Location

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