Provider Demographics
NPI:1548314016
Name:BODEN, ROBERT ALBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALBERT
Last Name:BODEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 UWCHAN AVE
Mailing Address - Street 2:ROBERT A BUDEN DDS
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341
Mailing Address - Country:US
Mailing Address - Phone:610-363-7658
Mailing Address - Fax:610-524-6839
Practice Address - Street 1:564 UWCHAN AVE
Practice Address - Street 2:ROBERT A BUDEN DDS
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341
Practice Address - Country:US
Practice Address - Phone:610-363-7658
Practice Address - Fax:610-524-6839
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS015592122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist