Organization
ORAL & FACIAL SURGERY CENTER PA
Active
Organization
ORAL & FACIAL SURGERY CENTER PA
Active
Other names
MAXILLOFACIAL SURGERY CENTER, ARKANSAS ORAL & FACIAL SURGERY CENTER PA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTTY L BOLDING DDS, MS (OWNER)
(479) 957-4611
Entity
Organization
Contact information
Practice address
3996 N FRONTAGE RD, FAYETTEVILLE, AR 72703-5122
(479) 582-3002
(479) 582-2840
Mailing address
PO BOX 4185, FAYETTEVILLE, AR 72702-4185
(479) 717-1171
(479) 927-3085
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127319680
—
AR
05
—
230273680
—
AR
05
—
239128680
—
AR
Enumeration date
05/09/2006
Last updated
06/07/2022
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