Provider Demographics
NPI:1942689112
Name:BOLD DENTAL SEARCY
Entity Type:Organization
Organization Name:BOLD DENTAL SEARCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-521-2653
Mailing Address - Street 1:PO BOX 1108
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-1108
Mailing Address - Country:US
Mailing Address - Phone:479-439-9192
Mailing Address - Fax:479-725-2395
Practice Address - Street 1:407 LLAMA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4786
Practice Address - Country:US
Practice Address - Phone:501-279-7779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOLD DENTAL PARTNERS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR30251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty