Healthcare Provider Details

I. General information

NPI: 1609489814
Provider Name (Legal Business Name): CHARLES THOMAS BOND II DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 WAUKEGAN RD
NORTHBROOK IL
60062-4662
US

IV. Provider business mailing address

1107 WAUKEGAN RD
NORTHBROOK IL
60062-4662
US

V. Phone/Fax

Practice location:
  • Phone: 224-904-2299
  • Fax: 224-904-2255
Mailing address:
  • Phone: 224-904-2299
  • Fax: 224-904-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number019032532
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: