Scotty L Bolding, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

3025 Issued in AR

Practice address

3333 S Pinnacle Hills Pkwy Ste 140
Rogers, AR 72758-8953

Phone

(479) 755-3000

Fax

(479) 616-1914

NPI assigned

Jan 5, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 9

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Feb 1, 2016 through Feb 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• FL HMO C-SNP
• FL HMO D-SNP

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oral & Facial Surgery Center PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Fayetteville, AR
  • NPI 1891744462
  NPD Authorized official
• Precident of New Jersey, LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Clifton, NJ
  • NPI 1699346437
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683849600000",
    "number": "1013064310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4185",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727024185",
            "telephone_number": "479-582-3000",
            "fax_number": "479-927-3085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 S PINNACLE HILLS PKWY STE 140",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727588953",
            "telephone_number": "479-755-3000",
            "fax_number": "479-616-1914"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3996 N Frontage Rd",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "AR",
            "postal_code": "727035122",
            "country_code": "US",
            "telephone_number": "479-582-3002",
            "fax_number": "479-582-2840",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "390 4th St N",
            "address_purpose": "LOCATION",
            "city": "St Petersburg",
            "state": "FL",
            "postal_code": "337012802",
            "country_code": "US",
            "telephone_number": "727-397-8503",
            "fax_number": "727-398-2679",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1135 Broad St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Clifton",
            "state": "NJ",
            "postal_code": "070133346",
            "country_code": "US",
            "telephone_number": "973-256-0103",
            "fax_number": "973-256-8066",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLDING",
        "first_name": "SCOTTY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-05",
        "last_updated": "2023-05-12",
        "certification_date": "2023-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NJ",
            "license": "22D102335600",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "16037",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN22477",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NJ",
            "license": "22D102335600",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MO",
            "license": "2001031902",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "AR",
            "license": "3025",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "FL",
            "license": "DN22477",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "TX",
            "license": "16037",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AR",
            "license": "3025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mallory Leigh Bockelman, LPC
• Body Positive Therapy, PLLC
• Jennifer Diane Boehm, LPC
• Jennifer Ann Boggs, WHNP
• Bohannan Anesthesia PLLC
• Megan Michelle Bolin
• Sara Elizabeth Bond, OTR/L
• Daisy Bonilla
• Daizy Bonilla, MHPP
• Bonner Orthodontics, PLLC

• Oral and Maxillofacial Surgery (Dentist) in Rogers, AR
• Providers in Rogers, AR by specialty
• Oral and Maxillofacial Surgery (Dentist) in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.