Provider Demographics
NPI:1205043478
Name:BOND, KEVIN PAGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PAGE
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 1:2701 COLTSGATE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-3581
Mailing Address - Country:US
Mailing Address - Phone:804-477-2919
Mailing Address - Fax:704-366-8717
Practice Address - Street 1:2701 COLTSGATE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3534
Practice Address - Country:US
Practice Address - Phone:804-477-2919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0442000047390200000X
NC83151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery