Timothy John Jernberg, D.M.D.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

DN27423 Issued in FL

Practice address

8899 Timberwilde Dr Ste 3
Bonita Springs, FL 34135-7896

Phone

(239) 498-7668

NPI assigned

Jun 18, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

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

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bonita Endodontic Associates, PLLC

  • Endodontics
  • Bonita Springs, FL
  • NPI 1801595210
  NPD
• Nathan C. Dewsnup DMD, Ms, LLC

  • Endodontics
  • Bonita Springs, FL
  • NPI 1881181030
  NPD (past)
• Commerce Drive Dental Group

  • General Practice Dentistry
  • North Mankato, MN
  • NPI 1447337803
  NPD (past)

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

{
    "created_epoch": "1371513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675728000000",
    "number": "1285073700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8899 TIMBERWILDE DR STE 3",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341357896",
            "telephone_number": "239-498-7668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8899 TIMBERWILDE DR STE 3",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341357896",
            "telephone_number": "239-498-7668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JERNBERG",
        "first_name": "TIMOTHY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-18",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D008752",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "MN",
            "license": "D13301",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "FL",
            "license": "DN27423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott H Jaffe, M.D
• Gabriela Jamur
• Javier Alfonso de la Cruz, PLLC
• JCR DMD LC
• Je Med Supplies and Services LC
• Jessica Carr, LMHC, LLC
• Jimmy Liu, M.D., P.a.
• Tatjana Jobsky
• Debra Johnson, M.ED.
• James Thomas Johnson, CRNA

• Endodontics in Bonita Springs, FL
• Providers in Bonita Springs, FL by specialty
• Endodontics in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; 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.