Jernberg, Gary Robert

Jernberg, Gary Robert is an sole proprietor health care provider with primary practice located at 99 Navaho Ave Suite 102, Mankato MN 56001-4876. He recently has only one registered license in Dental Providers / Periodontics, which is considered as his primary health care specialty. Jernberg, Gary Robert can be contacted via phone (507) 345-7537.

Contact Information

Primary practice address
99 Navaho Ave Suite 102 Mankato MN 56001-4876
Phone: (507) 345-7537
Fax: (507) 345-7538
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Periodontics 1223P0300X 8671 Minnesota

Profile Details

NPI number 1164420675
LBN Legal business name Jernberg, Gary Robert
Credentials D.D.S., M.S.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 8th, 2005
Last updated Jan 28th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164420675 NPPES
Pennsylvania Other 839878 UNITED CONCORDIA MILITARY
Pennsylvania Other 1B005JE UNITED CONCORDIA MILITARY
Pennsylvania MEDICAID 434218600 UNITED CONCORDIA MILITARY

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