Provider Demographics
NPI:1609464205
Name:PRECIDENT FLORIDA PLLC
Entity Type:Organization
Organization Name:PRECIDENT FLORIDA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOLDING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:479-957-4611
Mailing Address - Street 1:PO BOX 2523
Mailing Address - Street 2:DEPT 4316
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-2523
Mailing Address - Country:US
Mailing Address - Phone:727-397-8503
Mailing Address - Fax:727-397-2679
Practice Address - Street 1:390 4TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-2802
Practice Address - Country:US
Practice Address - Phone:727-397-8503
Practice Address - Fax:727-398-2679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN19562OtherFL STATE LICENSE
FLDN22588OtherFL STATE LICENSE
FLDN8054OtherFL STATE LICENSE
FLDN26035OtherFL STATE LICENSE