Provider Demographics
NPI:1528117900
Name:BOND, JOHN DAVID (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:BOND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 S IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-1613
Mailing Address - Country:US
Mailing Address - Phone:574-288-5252
Mailing Address - Fax:574-288-7270
Practice Address - Street 1:915 S IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-1613
Practice Address - Country:US
Practice Address - Phone:574-288-5252
Practice Address - Fax:574-288-7270
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006577A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice