Jenna Bergin Ude, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D13067 Issued in MN

Practice address

15167 Edgewood Dr
Brainerd, MN 56401-6946

Phone

(218) 828-0565

NPI assigned

Apr 28, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1335571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337817600000",
    "number": "1144588070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11700 WOOD DR SW",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564012386",
            "telephone_number": "218-330-7008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15167 EDGEWOOD DR",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564016946",
            "telephone_number": "218-828-0565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UDE",
        "first_name": "JENNA",
        "middle_name": "BERGIN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-28",
        "last_updated": "2012-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D13067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Timpane
• Steven Michael Trebil, BC-HIS
• Becky Twamley
• Audrey Jean Twit, PHARMD
• Nicolle Marie Uban, PHD, APRN, CNM
• Valhalla Place Brainerd LLC
• Jon Richard Van Der Hagen, MD
• Alexa Vanalst
• Dannia Lor Vang, PHARMD
• John Vanmoer

• General Practice Dentistry in Brainerd, MN
• Providers in Brainerd, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.