Provider Demographics
NPI:1619374691
Name:ARKANSAS ORAL & FACIAL SURGERY CENTER FORT SMITH PLLC
Entity Type:Organization
Organization Name:ARKANSAS ORAL & FACIAL SURGERY CENTER FORT SMITH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
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:479-717-1171
Mailing Address - Street 1:8309 PHOENIX AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-6141
Mailing Address - Country:US
Mailing Address - Phone:479-434-4430
Mailing Address - Fax:479-434-4438
Practice Address - Street 1:8309 PHOENIX AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6141
Practice Address - Country:US
Practice Address - Phone:479-434-4430
Practice Address - Fax:479-434-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty