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Organization
FAMILY AND COSMETIC GENTLE DENTISTRY
Active
Organization
FAMILY AND COSMETIC GENTLE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT LUTHER BODIN DDS (DENTIST)
(952) 224-9774
Entity
Organization
Contact information
Practice address
1421 WAYZATA BLVD, SUITE 320, WAYZATA, MN 55391-1939
(952) 224-9774
(952) 224-9791
Mailing address
4100 SHORELINE DR, SUITE 4, SPRING PARK, MN 55384-4508
(952) 224-9774
(952) 224-9791
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952399685
—
MN
Enumeration date
06/16/2015
Last updated
06/16/2015
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