# SCOTT L BOLDING DDS MS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467077354
- **Authorized official:** DR. SCOTTY L BOLDING DDS (OWNER)
- **Authorized official phone:** (479) 957-4611

## Contact information

- **Practice address:** 703 MAIN ST DEPT OF, PATERSON, NJ 07503-2621
- **Practice address phone:** (973) 754-2290
- **Practice address fax:** (973) 754-2633
- **Mailing address:** PO BOX 8880, FAYETTEVILLE, AR 72703-0015
- **Mailing address phone:** (479) 313-8637
- **Mailing address fax:** (479) 582-2840

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | Yes |

## Other

- **Enumeration date:** 06/16/2020
- **Last updated:** 06/07/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 22DI02335600 | NJ STATE LICENSE | NJ |
| 01 | — | 22DI02335601 | NJ STATE BRANCH LICENSE | NJ |