Provider Demographics
NPI:1407225261
Name:PAPKE, JODI (RDH)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:PAPKE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 185TH LN NE
Mailing Address - Street 2:
Mailing Address - City:EAST BETHEL
Mailing Address - State:MN
Mailing Address - Zip Code:55092-9597
Mailing Address - Country:US
Mailing Address - Phone:763-742-4761
Mailing Address - Fax:
Practice Address - Street 1:2851 185TH LN NE
Practice Address - Street 2:
Practice Address - City:EAST BETHEL
Practice Address - State:MN
Practice Address - Zip Code:55092-9597
Practice Address - Country:US
Practice Address - Phone:763-742-4761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH9348124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist