Organization
FAMILY AND COSMETIC GENTLE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT LUTHER BODIN DDS (CEO/OWNER)
(952) 224-9783
Entity
Organization
Contact information
Practice address
7500 42ND AVE N, NEW HOPE, MN 55427-1225
(763) 533-0055
Mailing address
4100 SHORELINE DR, #4, SPRING PARK, MN 55384-4508
(952) 224-9783
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
11/17/2014
Last updated
11/17/2014
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