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General NPI Number Information
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NPI Number | 1306200167
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Entity Type | Individual
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Provider Name | MOLLY BODENDORFER DDS
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Gender | Female
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Dates
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Enumeration Date | 04/07/2016
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 2410 S 73RD ST
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City | OMAHA
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State | NE
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Zip | 68124-2395
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Country | US
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Telephone | 402-819-4977
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Fax |
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Provider Business Mailing Address
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Address Line | 365 N HALSTED ST APT 902
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City | CHICAGO
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State | IL
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Zip | 60661-1374
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Country | US
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Telephone | 316-655-3731
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 021.003036
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 7768
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License Number State | NE
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