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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