Individual
JACOB LEE DVORAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DT
Contact information
Practice address
309 HOLLY LN, MANKATO, MN 56001-5422
(507) 388-2120
Mailing address
2018 MEADOW ST, COLOGNE, MN 55322-9069
(952) 836-6805
Taxonomy
Speciality
Code
Description
License number
State
125J00000X
Dental Therapist
Primary
DT23
MN
Other
Enumeration date
05/06/2013
Last updated
05/06/2013
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