| NPI | 1588176630 |
|---|---|
| Former Legal Business Name | INTEGRATIVE DENTAL SPECIALISTS PLLC |
| 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 | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AR 3025) |
| 204E00000X Oral & Maxillofacial Surgery | |
| Enumeration Date | 2017-10-30 |
| Last Update Date | 2022-10-11 |