Individual
JORDAN DITTBERNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4700 WHITE BEAR PKWY, WHITE BEAR LAKE, MN 55110-3336
(651) 762-7677
Mailing address
7504 115TH ST N, WHITE BEAR LAKE, MN 55110-6182
(651) 308-1177
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1001789
WI
Other
Enumeration date
05/01/2018
Last updated
05/01/2018
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