MEDICARE: DR. JOHN LESLEY 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	1223E0200X	Endodontics	11157	TX

General Provider Information

NPI Number	:	1255546743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN LESLEY BOND DDS

Provider Business Mailing Address
First Line	:	3509 HULEN ST
Second Line	:	SUITE 205
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6862
Country	:	US
Telephone Number	:	817-738-1996
Fax Number	:

Provider Business Practice Location Address
First Line	:	3509 HULEN ST
Second Line	:	SUITE 205
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6862
Country	:	US
Telephone Number	:	817-738-1996
Fax Number	:

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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