# ORAL & FACIAL SURGERY CENTER PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MAXILLOFACIAL SURGERY CENTER, ARKANSAS ORAL & FACIAL SURGERY CENTER PA
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891744462
- **Authorized official:** DR. SCOTTY L BOLDING DDS, MS (OWNER)
- **Authorized official phone:** (479) 957-4611

## Contact information

- **Practice address:** 3996 N FRONTAGE RD, FAYETTEVILLE, AR 72703-5122
- **Practice address phone:** (479) 582-3002
- **Practice address fax:** (479) 582-2840
- **Mailing address:** PO BOX 4185, FAYETTEVILLE, AR 72702-4185
- **Mailing address phone:** (479) 717-1171
- **Mailing address fax:** (479) 927-3085

## Taxonomy

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

## Other

- **Enumeration date:** 05/09/2006
- **Last updated:** 06/07/2022