Healthcare Provider Details

I. General information

NPI: 1730262965
Provider Name (Legal Business Name): SIX DAY DENTAL & ORTHODONTICS N TEXAS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E HWY 1114
ROANOKE TX
76262
US

IV. Provider business mailing address

120 S DENTON TAP STE 100
COPPELL TX
75019
US

V. Phone/Fax

Practice location:
  • Phone: 817-567-8040
  • Fax: 817-567-8041
Mailing address:
  • Phone: 469-635-1105
  • Fax: 469-635-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number16129
License Number StateTX

VIII. Authorized Official

Name: DR. JOHN U BOND
Title or Position: DDS OWNER CEO
Credential: DDS
Phone: 469-635-1105