Provider Demographics
NPI:1164563219
Name:BOND, FORREST CARSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:FORREST
Middle Name:CARSON
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 1:1720 ASHLEY AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-5059
Mailing Address - Country:US
Mailing Address - Phone:530-662-4316
Mailing Address - Fax:530-666-4083
Practice Address - Street 1:255 W COURT ST STE C
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-2986
Practice Address - Country:US
Practice Address - Phone:530-666-2117
Practice Address - Fax:530-666-4083
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice