Provider Demographics
NPI:1457864100
Name:TARUNA S BOLDING DDS PA
Entity Type:Organization
Organization Name:TARUNA S BOLDING DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARUNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOLDING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-957-4612
Mailing Address - Street 1:5229 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-6219
Mailing Address - Country:US
Mailing Address - Phone:479-957-4612
Mailing Address - Fax:
Practice Address - Street 1:5229 SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-6219
Practice Address - Country:US
Practice Address - Phone:479-957-4612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR30621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163704608Medicaid
AR3062OtherAR DENTAL LICENSE