Provider Demographics
NPI:1114931896
Name:BOND, DENNIS DAVIS SR (DMD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:DAVIS
Last Name:BOND
Suffix:SR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4463 EAST DR
Mailing Address - Street 2:
Mailing Address - City:BELDEN
Mailing Address - State:MS
Mailing Address - Zip Code:38826-9597
Mailing Address - Country:US
Mailing Address - Phone:662-680-3864
Mailing Address - Fax:
Practice Address - Street 1:499 GLOSTER CREEK VLG STE F5A
Practice Address - Street 2:SUITE F-5A
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4631
Practice Address - Country:US
Practice Address - Phone:662-844-9580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2045-831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660396Medicaid