MEDICARE: DR. KEVIN PAGE BOND DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	0442000047	VA
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	8315	NC

General Provider Information

NPI Number	:	1205043478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN PAGE BOND DDS

Provider Business Mailing Address
First Line	:	2701 COLTSGATE RD STE 104
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-3581
Country	:	US
Telephone Number	:	804-477-2919
Fax Number	:	704-366-8717

Provider Business Practice Location Address
First Line	:	2701 COLTSGATE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-3534
Country	:	US
Telephone Number	:	804-477-2919
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	03/13/2013

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