Provider Demographics
NPI:1821215526
Name:BODEN, DAVID F (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:F
Last Name:BODEN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 SW SAINT LUCIE WEST BLVD
Mailing Address - Street 2:SUITE #104
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1780
Mailing Address - Country:US
Mailing Address - Phone:772-878-2000
Mailing Address - Fax:772-878-2807
Practice Address - Street 1:1100 SW SAINT LUCIE WEST BLVD
Practice Address - Street 2:SUITE #104
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1780
Practice Address - Country:US
Practice Address - Phone:772-878-2000
Practice Address - Fax:772-878-2807
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL102531223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics