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General NPI Number Information
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NPI Number | 1699346437
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Entity Type | Organization
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Legal Business Name | PRECIDENT OF NEW JERSEY, LLC
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Dates
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Enumeration Date | 07/02/2021
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Last Update Date | 05/12/2023
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Provider Practice Location Address
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Address Line | 1135 BROAD ST STE 100
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City | CLIFTON
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State | NJ
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Zip | 07013-3346
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Country | US
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Telephone | 973-256-0103
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Fax | 973-256-8066
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Provider Business Mailing Address
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Address Line | PO BOX 2714 DEPT 2243
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City | CONWAY
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State | AR
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Zip | 72033-2714
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Country | US
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Telephone | 973-256-0103
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Fax | 973-256-8066
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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, MS
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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 | 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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Taxonomy #2
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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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