Individual
PAYTON LEE PENDERGAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DT
Contact information
Practice address
309 HOLLY LN, MANKATO, MN 56001-5422
(507) 388-2120
Mailing address
309 HOLLY LN, MANKATO, MN 56001-5422
(507) 514-8309
Taxonomy
Speciality
Code
Description
License number
State
125J00000X
Dental Therapist
Primary
DT189
MN
Other
Enumeration date
07/15/2025
Last updated
10/13/2025
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