Provider Demographics
NPI:1083011928
Name:GENTLE DENTISTRY OF MINNESOTA, LTD
Entity Type:Organization
Organization Name:GENTLE DENTISTRY OF MINNESOTA, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LUTHER
Authorized Official - Last Name:BODIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-224-9770
Mailing Address - Street 1:4100 SHORELINE DRIVE #4
Mailing Address - Street 2:
Mailing Address - City:SPRING PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55384
Mailing Address - Country:US
Mailing Address - Phone:952-224-9783
Mailing Address - Fax:952-746-0866
Practice Address - Street 1:8074 OLD CARRIAGE CT
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379
Practice Address - Country:US
Practice Address - Phone:952-746-0808
Practice Address - Fax:952-746-0866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty