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 |
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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 |
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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 |
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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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