MEDICARE: KEVIN P BOND DDS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	8315	NC

General Provider Information

NPI Number	:	1841500246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEVIN P BOND DDS PLLC

Provider Business Mailing Address
First Line	:	3000 UNITED FOUNDERS BLVD
Second Line	:	SUITE 237
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-3958
Country	:	US
Telephone Number	:	405-848-7974
Fax Number	:	405-848-0033

Provider Business Practice Location Address
First Line	:	2701 COLTSGATE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-3534
Country	:	US
Telephone Number	:	877-667-7669
Fax Number	:	405-848-0033

Authorized Official
Title or Position	:	CREDENTIALING REP
Name	:	LISA KEOUGH
Credential	:
Telephone Number	:	405-848-7974

Provider Enumeration Date	:	10/19/2010
Last Update Date	:	10/19/2010

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