| NPI | 1154045599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTTY L BOLDING Owner 479-957-4611 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2022-09-29 |
| Last Update Date | 2022-10-11 |