Organization
SCOTT L BOLDING DDS MS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTTY L BOLDING DDS (OWNER)
(479) 957-4611
Entity
Organization
Contact information
Practice address
703 MAIN ST DEPT OF, PATERSON, NJ 07503-2621
(973) 754-2290
(973) 754-2633
Mailing address
PO BOX 8880, FAYETTEVILLE, AR 72703-0015
(479) 313-8637
(479) 582-2840
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22DI02335600
NJ STATE LICENSE
NJ
01
—
22DI02335601
NJ STATE BRANCH LICENSE
NJ
Enumeration date
06/16/2020
Last updated
06/07/2022
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