Individual
JACOBY JOANNE HERNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
816 W SAINT GERMAIN ST STE 101, SAINT CLOUD, MN 56301-3511
(320) 252-2454
Mailing address
1827 36TH ST S, SAINT CLOUD, MN 56301-4581
(612) 532-0046
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
1001932-15
WI
1223G0001X
General Practice Dentistry
Primary
D14481
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/08/2018
Last updated
11/29/2021
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