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Organization
JACOB L. BARTHOLD DDS, PA
Active
Organization
JACOB L. BARTHOLD DDS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB LEE BARTHOLD DDS (PRESIDENT)
(763) 746-6567
Entity
Organization
Contact information
Practice address
69 LAKE ST N STE 100, FOREST LAKE, MN 55025-2527
(763) 746-6567
Mailing address
107 E BRIDGE ST, REDWOOD FALLS, MN 56283-1621
(763) 746-6567
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D13073
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457613028
—
MN
Enumeration date
07/26/2017
Last updated
07/26/2017
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