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Organization
HERNICK FAMILY DENTAL PLLC
Active
Organization
HERNICK FAMILY DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOBY HERNICK DDS (OWNER)
(612) 532-0046
Entity
Organization
Contact information
Practice address
4220 W OLD SHAKOPEE RD STE 221, BLOOMINGTON, MN 55437-2949
(952) 881-0201
Mailing address
4200 W OLD SHAKOPEE RD STE 221, BLOOMINGTON, MN 55437-2967
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
09/29/2023
Last updated
09/29/2023
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