NPIMap

Organization Active NPI

Family & Cosmetic Gentle Dentistry, LTD

Doing business as 'Gentle Dentistry'

  • General Practice Dentistry
  • Coon Rapids, MN
National Provider Identifier
1477112456
Registry record updated Jun 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
FAMILY & COSMETIC GENTLE DENTISTRY, LTD
Doing business as
'Gentle Dentistry'
Practice address
2147 Northdale Blvd NW
Coon Rapids, MN 55433
Phone
(651) 209-3139
NPI assigned
Jun 12, 2019
Last updated
Jun 12, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Robert Luther Bodin, D.D.S.
Title
Owner/Ceo
Phone
(952) 224-9788

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

2147 Northdale Blvd NW
Coon Rapids, MN 55433

Mailing address

2147 Northdale Blvd NW
Coon Rapids, MN 55433
Phone (651) 209-3139

Other identifiers 1

IdentifierTypeStateIssuer
256415000MedicaidMN

Other names 1

  • 'Gentle Dentistry' Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Family and Cosmetic Gentle Dentistry16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Locations

2147 Northdale Blvd NW
Coon Rapids, MN 55433
Phone (763) 497-6977

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560297600000",
    "number": "1477112456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2147 NORTHDALE BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "55433",
            "telephone_number": "651-209-3139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2147 NORTHDALE BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "55433",
            "telephone_number": "651-209-3139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY & COSMETIC GENTLE DENTISTRY, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-12",
        "last_updated": "2019-06-12",
        "status": "A",
        "authorized_official_last_name": "BODIN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "LUTHER",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "952-224-9788",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256415000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "'Gentle Dentistry'",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coon Rapids, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.