Provider Demographics
NPI:1467077354
Name:SCOTT L BOLDING DDS MS PC
Entity Type:Organization
Organization Name:SCOTT L BOLDING DDS MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOLDING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-957-4611
Mailing Address - Street 1:PO BOX 8880
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-0015
Mailing Address - Country:US
Mailing Address - Phone:479-313-8637
Mailing Address - Fax:479-582-2840
Practice Address - Street 1:703 MAIN ST DEPT OF
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2621
Practice Address - Country:US
Practice Address - Phone:973-754-2290
Practice Address - Fax:973-754-2633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22DI02335601OtherNJ STATE BRANCH LICENSE
NJ22DI02335600OtherNJ STATE LICENSE
FLDN8054OtherFL DENTAL LICENSE