Provider Demographics
NPI:1083969570
Name:JASON T. BOLDING DDS PC
Entity Type:Organization
Organization Name:JASON T. BOLDING DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:T
Authorized Official - Last Name:BOLDING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:501-279-7779
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-0099
Mailing Address - Country:US
Mailing Address - Phone:479-717-1175
Mailing Address - Fax:479-725-2395
Practice Address - Street 1:407 LLAMA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4786
Practice Address - Country:US
Practice Address - Phone:501-279-7779
Practice Address - Fax:501-279-2047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR32221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty