Healthcare Provider Details

I. General information

NPI: 1659066322
Provider Name (Legal Business Name): AUSTIN THORNE BOND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 N LOOP 336 W STE C
CONROE TX
77304-3672
US

IV. Provider business mailing address

204 LAKE ESTATES DR
MONTGOMERY TX
77356-4806
US

V. Phone/Fax

Practice location:
  • Phone: 936-242-4031
  • Fax:
Mailing address:
  • Phone: 972-904-9844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number42730
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: