Provider Demographics
NPI:1699579458
Name:BODDE, HENRY CLAY (DDS)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:CLAY
Last Name:BODDE
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E 46TH ST APT 7
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-1707
Mailing Address - Country:US
Mailing Address - Phone:314-601-1950
Mailing Address - Fax:
Practice Address - Street 1:1 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2432
Practice Address - Country:US
Practice Address - Phone:708-948-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program