Organization
JACOB L. BARTHOLD DDS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB LEE BARTHOLD DDS (PRESIDENT)
(763) 746-6567
Entity
Organization
Contact information
Practice address
69 LAKE ST N STE 100, FOREST LAKE, MN 55025-2527
(763) 746-6567
Mailing address
107 E BRIDGE ST, REDWOOD FALLS, MN 56283-1621
(763) 746-6567
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D13073
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457613028
—
MN
Enumeration date
07/26/2017
Last updated
07/26/2017
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