Organization
FAMILY & COSMETIC GENTLE DENTISTRY, LTD
Active
Other names
'Gentle Dentistry'
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT LUTHER BODIN D.D.S. (OWNER/CEO)
(952) 224-9788
Entity
Organization
Contact information
Practice address
2147 NORTHDALE BLVD NW, COON RAPIDS, MN 55433
(651) 209-3139
Mailing address
2147 NORTHDALE BLVD NW, COON RAPIDS, MN 55433
(651) 209-3139
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
256415000
—
MN
Enumeration date
06/12/2019
Last updated
06/12/2019
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