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 |