Provider Demographics
NPI:1073826731
Name:JAMES RUSSELL BOND DMD PC
Entity Type:Organization
Organization Name:JAMES RUSSELL BOND DMD PC
Other - Org Name:JAMES BOND DENTAL ARTS.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:406-579-2165
Mailing Address - Street 1:1958 STADIUM DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715
Mailing Address - Country:US
Mailing Address - Phone:406-586-5008
Mailing Address - Fax:406-587-6181
Practice Address - Street 1:1958 STADIUM DR
Practice Address - Street 2:SUITE 1
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715
Practice Address - Country:US
Practice Address - Phone:406-586-5008
Practice Address - Fax:406-587-6181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT23671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1770714081Medicaid