Individual
DR. JODI MICHELLE FONKERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1101 SOUTH FIRST STREET, SUITE 3, WILLMAR, MN 56201
(320) 235-2780
(320) 235-8838
Mailing address
1101 SOUTH FIRST STREET, SUITE 3, WILLMAR, MN 56201
(320) 235-2780
(320) 235-8838
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D10807
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30751330
—
MN
Enumeration date
10/25/2006
Last updated
07/08/2007
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