Individual
DR. JOHN LEONARD BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
323 N LEROUX ST STE 100, FLAGSTAFF, AZ 86001-4542
(928) 774-1168
(928) 779-6349
Mailing address
323 N LEROUX ST STE 100, FLAGSTAFF, AZ 86001-4542
(928) 774-1168
(928) 779-6349
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3596
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3596
STATE LICENSE
AZ
Enumeration date
02/07/2007
Last updated
04/03/2020
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