Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 2910 | SC |
NPI | 1003997669 |
---|---|
Provider Name | Philip Bonds |
First Address | Florence, SC 29505-2841 |
Second Address | Florence, SC 29505-2841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |