NPIMap

Organization Active NPI

Precident of New Jersey, LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Clifton, NJ
National Provider Identifier
1699346437
Registry record updated May 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
PRECIDENT OF NEW JERSEY, LLC
Practice address
1135 Broad St Ste 100
Clifton, NJ 07013-3346
Phone
(973) 256-0103
Fax
(973) 256-8066
NPI assigned
Jul 2, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2023

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

Authorized official

Name
Dr. Scotty L Bolding, DDS, MSNPI 1013064310
Title
Owner
Phone
(479) 957-4611

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X Primary
Oral & Maxillofacial Surgery (D.M.D.)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 204E00000X

Addresses

Primary practice location

1135 Broad St Ste 100
Clifton, NJ 07013-3346

Mailing address

PO Box 2714
Dept 2243
Conway, AR 72033-2714
Phone (973) 256-0103

Other identifiers 2

IdentifierTypeStateIssuer
22DI02335600OtherNJNJ STATE LICENSE
22DI02335601OtherNJNJ STATE LICENSE BRANCH OFFICE

National Provider Directory

National Provider Directory

Locations

50 E Main St
Ste 3
Little Falls, NJ 07424
Phone (973) 256-0103

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1625184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683849600000",
    "number": "1699346437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2714",
            "address_2": "DEPT 2243",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720332714",
            "telephone_number": "973-256-0103",
            "fax_number": "973-256-8066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 BROAD ST STE 100",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070133346",
            "telephone_number": "973-256-0103",
            "fax_number": "973-256-8066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRECIDENT OF NEW JERSEY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-02",
        "last_updated": "2023-05-12",
        "certification_date": "2023-05-12",
        "status": "A",
        "authorized_official_last_name": "BOLDING",
        "authorized_official_first_name": "SCOTTY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-957-4611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NJ STATE LICENSE",
            "identifier": "22DI02335600",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NJ STATE LICENSE BRANCH OFFICE",
            "identifier": "22DI02335601",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clifton, NJ

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.