Individual
JARVARIS BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
209 S 1ST ST, MONTEVIDEO, MN 56265-1412
(320) 269-6406
Mailing address
2429 3RD AVE SE UNIT A, WILLMAR, MN 56201-4465
(678) 588-4533
Taxonomy
Speciality
Code
Description
License number
State
125J00000X
Dental Therapist
Primary
103
MN
Other
Enumeration date
01/18/2019
Last updated
01/18/2019
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