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General NPI Number Information
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NPI Number | 1467077354
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Entity Type | Organization
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Legal Business Name | SCOTT L BOLDING DDS MS PC
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Dates
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Enumeration Date | 06/16/2020
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 703 MAIN ST DEPT OF
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City | PATERSON
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State | NJ
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Zip | 07503-2621
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Country | US
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Telephone | 973-754-2290
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Fax | 973-754-2633
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Provider Business Mailing Address
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Address Line | PO BOX 8880
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-0015
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Country | US
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Telephone | 479-313-8637
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Fax | 479-582-2840
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Authorized Official
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Title or Position | OWNER
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Name | DR. SCOTTY L BOLDING
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Credential | DDS
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Telephone | 479-957-4611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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