Provider Demographics
NPI:1013064310
Name:BOLDING, SCOTTY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTTY
Middle Name:L
Last Name:BOLDING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4185
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-4185
Mailing Address - Country:US
Mailing Address - Phone:479-582-3000
Mailing Address - Fax:479-927-3085
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
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1023356001223S0112X, 204E00000X
TX160371223S0112X, 204E00000X
FLDN224771223S0112X, 204E00000X
MO2001031902204E00000X
AR3025204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery