Provider Demographics
NPI:1134526106
Name:MAXSURGE DENTAL SPECIALIST
Entity type:Organization
Organization Name:MAXSURGE DENTAL SPECIALIST
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:DDS, MS
Authorized Official - Phone:479-582-3000
Mailing Address - Street 1:520 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-3442
Mailing Address - Country:US
Mailing Address - Phone:870-741-3877
Mailing Address - Fax:870-741-2406
Practice Address - Street 1:520 N PINE ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3442
Practice Address - Country:US
Practice Address - Phone:870-741-3877
Practice Address - Fax:870-741-2406
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