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PAYTON LEE PENDERGAST DT
NPI 1265324388
Dental Therapist in Mankato, MN

Active since July 15, 2025
309 HOLLY LN, MANKATO, MN 56001(507) 388-2120 Get Directions Write a Review

NPPES record last updated: October 13, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Payton Lee Pendergast Dt NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PAYTON LEE PENDERGAST DT (NPI 1265324388) is an individual dental therapist in Mankato, Minnesota, licensed in Minnesota (DT189) and active in the NPI registry since July 2025.

NPPES Registry Identity

NPI1265324388
Entity TypeIndividualFemale
Primary Taxonomy125J00000X
Provider Legal NamePAYTON LEE PENDERGASTCredential: DT
Location Address309 HOLLY LNMankato, MN 56001-5422
Mailing Address309 Holly LnMankato, MN 56001-5422 · (507) 514-8309
Phone(507) 388-2120
Sole ProprietorNo
Enumeration DateJuly 15, 2025
Last NPPES UpdateOctober 13, 2025
NPPES CertifiedOctober 13, 2025
✔ NPI 1265324388 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDental TherapistDental Providers
Taxonomy Code125J00000X
License✔ Licensed in MN · DT189
Definition
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 therapist and state dental practice acts and regulations.
309 HOLLY LN, Mankato, MN 56001
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GRACE CHALGREN DDS
Dentist
309 HOLLY LN
MANKATO, MN 56001
Blue Earth County (218) 280-9091
MISS CALLIE JO HANSON RDH, MDT
Dental Therapist
309 HOLLY LN
MANKATO, MN 56001
Blue Earth County (507) 388-2120
MS. ANN MICHELLE DAUFFENBACH THOMPSON MS LMFT
Marriage & Family Therapist
309 HOLLY LN
MANKATO, MN 56001
Blue Earth County (507) 344-5517
DR. MEAGAN KAYE GOVIG DDS
Dentist (General Practice)
309 HOLLY LN
MANKATO, MN 56001
Blue Earth County (507) 388-2120
JACOB LEE DVORAK DT
Dental Therapist
309 HOLLY LN
MANKATO, MN 56001
Blue Earth County (507) 388-2120
JESSICA HADLER MDT/RDH
Dental Hygienist
309 HOLLY LN
MANKATO, MN 56001
Blue Earth County (507) 388-2120
DR. JANE MUGAMBI DNP
Nurse Practitioner (Psychiatric/Mental Health)
309 HOLLY LN
MANKATO, MN 56001
Blue Earth County (507) 388-2120
CORI LYNN WASZ
Nurse Practitioner (Family)
309 HOLLY LN
MANKATO, MN 56001
Blue Earth County (507) 388-2120

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Payton Pendergast's NPI number?

The NPI number for Payton Pendergast is 1265324388. It was assigned to this individual provider in the NPPES registry on July 15, 2025.

Where is Payton Pendergast located?

Payton Pendergast practices at 309 Holly Ln, Mankato, MN 56001. The listed phone number is (507) 388-2120.

What is Payton Pendergast's specialty?

The primary specialty registered for this NPI is Dental Therapist with taxonomy code 125J00000X.

When was this NPI record last updated?

The NPPES record for Payton Pendergast was last updated on October 13, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.