South Park Oral Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

SOUTH PARK ORAL SURGERY

Doing business as

South Park Oral Surgery

Practice address

2719 Coltsgate Rd
Charlotte, NC 28211-3502

Phone

(704) 366-8707

Fax

(704) 366-8717

NPI assigned

Apr 17, 2023

Last updated

Apr 17, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kevin P BondNPI 1205043478

Title

Dentist/Owner

Phone

(704) 366-8707

Specialties & licenses 1

Addresses

Other names 1

• South Park Oral Surgery Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevin Page Bond, DDS

  • Student in an Organized Health Care Education/Training Program
  • Charlotte, NC
  • NPI 1205043478

  Oral and Maxillofacial Surgery

  NPD Authorized official
• Wesley Tyler McWatters, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Charlotte, NC
  • NPI 1770147472
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681689600000",
    "number": "1003502519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2719 COLTSGATE RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282113502",
            "telephone_number": "704-366-8707",
            "fax_number": "704-366-8717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2719 COLTSGATE RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282113502",
            "telephone_number": "704-366-8707",
            "fax_number": "704-366-8717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH PARK ORAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-17",
        "last_updated": "2023-04-17",
        "certification_date": "2023-04-17",
        "status": "A",
        "authorized_official_last_name": "BOND",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "704-366-8707",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Park Oral Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• South East Mecklenburg County Health Department
• South Fork Optometric Associates, P.a.
• South Lake Pediatrics
• South Park Aesthetics
• South Park Behavioral
• Katherine Allison South
• Southcross Family Medicine PLLC
• Southcross Family Medicine PLLC
• Southeast Addiction Institute and Learning Center, Inc (Sail)
• Southeast Anesthesiology Consultants, PLLC

• Oral and Maxillofacial Surgery (Dentist) in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Oral and Maxillofacial Surgery (Dentist) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.