Provider Demographics
NPI:1700219912
Name:BOND 2020 DENTAL, LLC
Entity Type:Organization
Organization Name:BOND 2020 DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S.
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-549-7232
Mailing Address - Street 1:915 S. IRONWOOD
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:574-288-7279
Practice Address - Street 1:915 S IRONWOOD
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:574-288-7279
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:20-20 DENTAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008811A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty