Individual
DR. GARY ROBERT JERNBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.D.
Contact information
Practice address
99 NAVAHO AVE, SUITE 102, MANKATO, MN 56001-4876
(507) 345-7537
(507) 345-7538
Mailing address
99 NAVAHO AVE, SUITE 102, MANKATO, MN 56001-4876
(507) 345-7537
(507) 345-7538
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
8671
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1B005JE
BCBS OF MN
MN
05
—
434218600
—
MN
01
—
839878
UNITED CONCORDIA MILITARY
PA
Enumeration date
07/08/2005
Last updated
01/28/2011
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