| Family & Cosmetic Gentle Dentistry, Ltd | |
|
2147 Northdale Blvd Nw Coon Rapids MN 55433 | |
| (651) 209-3139 | |
| Not Available |
| Full Name | Family & Cosmetic Gentle Dentistry, Ltd |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2147 Northdale Blvd Nw, Coon Rapids, Minnesota |
| Authorized Official Name and Position | Robert Luther Bodin (OWNER/CEO) |
| Authorized Official Contact | 9522249788 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Family & Cosmetic Gentle Dentistry, Ltd 2147 Northdale Blvd Nw Coon Rapids MN 55433 Ph: (651) 209-3139 | Family & Cosmetic Gentle Dentistry, Ltd 2147 Northdale Blvd Nw Coon Rapids MN 55433 Ph: (651) 209-3139 |
| NPI Number | 1477112456 |
|---|---|
| Provider Enumeration Date | 06/12/2019 |
| Last Update Date | 06/12/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477112456 | NPI | - | NPPES |
| 256415000 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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