Individual provider · Type 1 NPI

Payton Lee Pendergast, DT

Dental Therapist · Mankato, MN

NPI number 1265324388 Active

Practice location

309 Holly Ln
Mankato, MN 56001-5422

Call (507) 388-2120 Map

Specialties and licenses

TaxonomyCodeLicense
Dental Therapist Primary 125J00000XDT189 (MN)

Dental Therapist: A Dental Therapist is an individual who has completed an accredited or non-accredited dental therapy program and who has been authorized by the relevant state board or a tribal entity to provide services within the scope of their practice under the supervision of a dentist. Functions that may be delegated to the dental therapist vary based on the needs of the dentist, the educational preparation of the dental therap…

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About NPI 1265324388

Payton Lee Pendergast, DT's National Provider Identifier is 1265324388, issued on Jul 15, 2025. The primary taxonomy on file is Dental Therapist (125J00000X), and the practice location is in Mankato, MN. The record was last updated on Oct 13, 2025.