Healthcare Provider Details

I. General information

NPI: 1891259081
Provider Name (Legal Business Name): BOND BOND PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4608 DOGWOOD DR STE A
EVERETT WA
98203-2000
US

IV. Provider business mailing address

4608 DOGWOOD DR STE A
EVERETT WA
98203-2000
US

V. Phone/Fax

Practice location:
  • Phone: 425-258-2633
  • Fax:
Mailing address:
  • Phone: 360-789-3472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RYAN CHARLES BOND
Title or Position: DENTIST
Credential: DDS
Phone: 360-789-3472