| NPI | 1609464205 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT L BOLDING Owner 479-957-4611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| 204E00000X Oral & Maxillofacial Surgery | |
| Enumeration Date | 2021-01-08 |
| Last Update Date | 2022-06-07 |