NPI 1174968028

Jacob Lee Dvorak, DT

Practitioner Dental Therapist Mankato, MN

Practice location

Address: 309 Holly Ln, Mankato, MN 56001-5422
Phone: (507) 388-2120
Mailing address: 2018 Meadow St, Cologne, MN 55322-9069

Registered specialties

Dental Therapist Primary

Dental Providers Taxonomy 125J00000X Licence DT23 (MN)

Other Dental Therapist providers in Minnesota →

Registry record

NPI: 1174968028
Entity type: Individual
Sex (as registered): Male
NPI issued: 6 May 2013
Record last updated: 6 May 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.