Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 16037 | TX |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 22D102335600 | NJ |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 3025 | AR |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DN22477 | FL |
N | 204E00000X | Oral & Maxillofacial Surgeon | 16037 | TX |
N | 204E00000X | Oral & Maxillofacial Surgeon | 2001031902 | MO |
N | 204E00000X | Oral & Maxillofacial Surgeon | 22D102335600 | NJ |
N | 204E00000X | Oral & Maxillofacial Surgeon | 3025 | AR |
N | 204E00000X | Oral & Maxillofacial Surgeon | DN22477 | FL |
NPI | 1013064310 |
---|---|
Provider Name | Dr. Scotty L Bolding |
First Address | Fayetteville, AR 72702-4185 |
Second Address | Fayetteville, AR 72703-5122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 02/11/2021 |