Healthcare Provider Details

I. General information

NPI: 1588176630
Provider Name (Legal Business Name): PRECIDENT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 S PINNACLE HILLS PKWY STE 140
ROGERS AR
72758-8953
US

IV. Provider business mailing address

PO BOX 8549
FAYETTEVILLE AR
72703-0010
US

V. Phone/Fax

Practice location:
  • Phone: 479-755-3000
  • Fax: 479-616-1914
Mailing address:
  • Phone: 479-755-3000
  • Fax: 479-616-1914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3025
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTTY L BOLDING
Title or Position: OWNER
Credential: D.D.S.
Phone: 479-957-4611