Provider Demographics
NPI:1255546743
Name:BOND, JOHN LESLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LESLEY
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 1:3509 HULEN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6862
Mailing Address - Country:US
Mailing Address - Phone:817-738-1996
Mailing Address - Fax:
Practice Address - Street 1:3509 HULEN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6862
Practice Address - Country:US
Practice Address - Phone:817-738-1996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111571223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics