Provider Demographics
NPI:1588176630
Name:PRECIDENT, PLLC
Entity Type:Organization
Organization Name:PRECIDENT, PLLC
Other - Org Name:INTEGRATIVE DENTAL SPECIALISTS PLLC
Other - Org Type:Former Legal Business Name
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 8549
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-0010
Mailing Address - Country:US
Mailing Address - Phone:479-755-3000
Mailing Address - Fax:479-616-1914
Practice Address - Street 1:3333 S PINNACLE HILLS PKWY STE 140
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8953
Practice Address - Country:US
Practice Address - Phone:479-755-3000
Practice Address - Fax:479-616-1914
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORAL & FACIAL SURGERY CENTER PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-30
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR30251223S0112X, 1223S0112X
1223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty