| NPI | 1699346437 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTTY L BOLDING Owner 479-957-4611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery |
| Enumeration Date | 2021-07-02 |
| Last Update Date | 2023-05-12 |