Organization
GARY R. JERNBERG, D.D.S., M.S.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY ROBERT JERNBERG DDS,MSD (PERIODONTIST)
(507) 345-7537
Entity
Organization
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1B004JE
BCBS OF MN
MN
Enumeration date
04/25/2007
Last updated
08/22/2020
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