# SOUTH PARK ORAL SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** South Park Oral Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003502519
- **Authorized official:** DR. KEVIN P BOND (DENTIST/OWNER)
- **Authorized official phone:** (704) 366-8707

## Contact information

- **Practice address:** 2719 COLTSGATE RD, CHARLOTTE, NC 28211-3502
- **Practice address phone:** (704) 366-8707
- **Practice address fax:** (704) 366-8717
- **Mailing address:** 2719 COLTSGATE RD, CHARLOTTE, NC 28211-3502
- **Mailing address phone:** (704) 366-8707
- **Mailing address fax:** (704) 366-8717

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 04/17/2023
- **Last updated:** 04/17/2023