NPIMap

Organization Active NPI

Oral & Facial Surgery Center PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Fayetteville, AR
National Provider Identifier
1891744462
Registry record updated Jun 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
ORAL & FACIAL SURGERY CENTER PA
Practice address
3996 N Frontage Rd
Fayetteville, AR 72703-5122
Phone
(479) 582-3002
Fax
(479) 582-2840
NPI assigned
May 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2022

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

3996 N Frontage Rd
Fayetteville, AR 72703-5122

Mailing address

PO Box 4185
Fayetteville, AR 72702-4185
Phone (479) 717-1171

Other practice location 1

520 N Pine St
Harrison, AR 72601-3442
Phone (870) 741-3877

Other practice location 2

2926 W Huntsville Ave
Springdale, AR 72762-7726
Phone (479) 582-3000

Other identifiers 3

IdentifierTypeStateIssuer
127319680MedicaidAR
230273680MedicaidAR
239128680MedicaidAR

Other names 2

  • ARKANSAS ORAL & FACIAL SURGERY CENTER PA Doing business as
  • MAXILLOFACIAL SURGERY CENTER Former legal business name

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 7

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": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654560000000",
    "number": "1891744462",
    "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": "479-717-1171",
            "fax_number": "479-927-3085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3996 N FRONTAGE RD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035122",
            "telephone_number": "479-582-3002",
            "fax_number": "479-582-2840"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "520 N Pine St",
            "address_purpose": "LOCATION",
            "city": "Harrison",
            "state": "AR",
            "postal_code": "726013442",
            "country_code": "US",
            "telephone_number": "870-741-3877",
            "fax_number": "870-741-2406",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2926 W Huntsville Ave",
            "address_purpose": "LOCATION",
            "city": "Springdale",
            "state": "AR",
            "postal_code": "727627726",
            "country_code": "US",
            "telephone_number": "479-582-3000",
            "fax_number": "479-927-3085",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ORAL & FACIAL SURGERY CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2022-06-07",
        "certification_date": "2022-06-07",
        "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": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127319680",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "230273680",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "239128680",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ARKANSAS ORAL & FACIAL SURGERY CENTER PA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MAXILLOFACIAL SURGERY CENTER",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "MAXILLOFACIAL SURGERY CENTER",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2022; 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.