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General NPI Number Information
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NPI Number | 1700219912
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Entity Type | Organization
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Legal Business Name | BOND 2020 DENTAL, LLC
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Dates
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Enumeration Date | 08/12/2013
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Last Update Date | 08/12/2013
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Provider Practice Location Address
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Address Line | 915 S IRONWOOD
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City | SOUTH BEND
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State | IN
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Zip | 46615-1613
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Country | US
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Telephone | 574-288-5252
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Fax | 574-288-7279
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Provider Business Mailing Address
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Address Line | 915 S. IRONWOOD
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City | SOUTH BEND
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State | IN
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Zip | 46615-1613
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Country | US
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Telephone | 574-288-5252
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Fax | 574-288-7279
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Authorized Official
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Title or Position | D.D.S.
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Name | DR. WILLIAM MYERS
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Credential | D.D.S.
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Telephone | 574-549-7232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12008811A
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License Number State | IN
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