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General NPI Number Information
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NPI Number | 1609489814
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Entity Type | Individual
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Provider Name | CHARLES THOMAS BOND II DMD, MS
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Gender | Male
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Dates
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Enumeration Date | 08/27/2020
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 18243 HARWOOD AVE
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City | HOMEWOOD
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State | IL
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Zip | 60430-2149
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Country | US
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Telephone | 708-799-3030
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Fax |
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Provider Business Mailing Address
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Address Line | 3219 N SEMINARY AVE UNIT 3N
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City | CHICAGO
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State | IL
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Zip | 60657-3310
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Country | US
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Telephone | 773-739-2643
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 019032532
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License Number State | IL
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