Individual
DR. NATHAN LUCAS BOMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3405 PROMENADE AVE STE 300, EAGAN, MN 55123-4420
(651) 236-7458
Mailing address
2813 4TH ST SE UNIT 620, MINNEAPOLIS, MN 55414-3013
(262) 225-7291
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D14815
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D14815
STATE OF MINNESOTA BOARD OF DENTISTRY
MN
Enumeration date
01/09/2023
Last updated
01/09/2023
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