Jacob Lee Dvorak, DT Valid NPI
Individual provider · Dental Therapist · Mankato, MN
- NPI
- 1174968028
- Type
- Individual (Type 1)
- Primary specialty
- Dental Therapist
- Specialty group
- Dental Providers
- Taxonomy code
- 125J00000X
- License number
- DT23 (MN)
- Sex
- Male
- Sole proprietor
- No
- Enumerated
- 2013-05-06
- Last updated
- 2013-05-06
Practice location
309 Holly Ln
Mankato, MN 56001-5422
(507) 388-2120