Gary R. Jernberg, D.D.S., M.S.D.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

GARY R. JERNBERG, D.D.S., M.S.D.

Practice address

99 Navaho Ave
Suite 102
Mankato, MN 56001-4876

Phone

(507) 345-7537

Fax

(507) 345-7538

NPI assigned

Apr 25, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Gary Robert Jernberg, DDS,MSDNPI 1164420675

Title

Periodontist

Phone

(507) 345-7537

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gary Robert Jernberg, D.D.S., M.S.D.

  • Periodontics
  • Mankato, MN
  • NPI 1164420675
  NPD (past) Authorized official

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851510952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 NAVAHO AVE",
            "address_2": "SUITE 102",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014876",
            "telephone_number": "507-345-7537",
            "fax_number": "507-345-7538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 NAVAHO AVE",
            "address_2": "SUITE 102",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014876",
            "telephone_number": "507-345-7537",
            "fax_number": "507-345-7538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY R. JERNBERG, D.D.S., M.S.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JERNBERG",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PERIODONTIST",
        "authorized_official_telephone_number": "507-345-7537",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS,MSD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "1B004JE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily S Garfoot
• Amy Lou Garibay
• Sheri Lynn Garner, RN, IBCLC
• Peggy S Garofano
• Michael R Gartner, MD
• Marlena Renae Garza
• Todd J Gavin, MD
• Rodney Richard Gay, C.E.S.
• Derek Gearman, M.D.
• Ryan Gebur

• Periodontics in Mankato, MN
• Providers in Mankato, MN by specialty
• Periodontics in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.