Provider Demographics
NPI:1740374958
Name:BODEN, ROBERT S (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:BODEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 WEST BROADWAY
Mailing Address - Street 2:SUITE 1210
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2191
Mailing Address - Country:US
Mailing Address - Phone:502-584-2142
Mailing Address - Fax:502-584-2168
Practice Address - Street 1:332 WEST BROADWAY
Practice Address - Street 2:SUITE 1210
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2191
Practice Address - Country:US
Practice Address - Phone:502-584-2142
Practice Address - Fax:502-584-2168
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4314122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist