Provider Demographics
NPI:1598760605
Name:SYNHORST, JOHN BENJAMIN II (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BENJAMIN
Last Name:SYNHORST
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E 11TH ST
Mailing Address - Street 2:STE 201
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4363
Mailing Address - Country:US
Mailing Address - Phone:712-262-7350
Mailing Address - Fax:712-262-7351
Practice Address - Street 1:116 E 11TH ST
Practice Address - Street 2:STE 201
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4363
Practice Address - Country:US
Practice Address - Phone:712-262-7350
Practice Address - Fax:712-262-7351
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA059991223S0112X
MND97491223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN080020100Medicaid
IA0138928Medicaid
MN080020100Medicaid
MN190000607Medicare ID - Type Unspecified
IA0138928Medicaid