| Southern Minnesota Periodontics, Pa | |
|
99 Navaho Ave Suite 102 Mankato MN 56001-4876 | |
| (507) 345-7537 | |
| (507) 345-7538 |
| Full Name | Southern Minnesota Periodontics, Pa |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 99 Navaho Ave, Mankato, Minnesota |
| Authorized Official Name and Position | Gary Jernberg (OWNER) |
| Authorized Official Contact | 5073457537 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Minnesota Periodontics, Pa 99 Navaho Ave Suite 102 Mankato MN 56001-4876 Ph: (507) 345-7537 | Southern Minnesota Periodontics, Pa 99 Navaho Ave Suite 102 Mankato MN 56001-4876 Ph: (507) 345-7537 |
| NPI Number | 1609012624 |
|---|---|
| Provider Enumeration Date | 12/22/2008 |
| Last Update Date | 12/22/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609012624 | NPI | - | NPPES |
| 000839878 | Other | PA | UNITED CONCORDIA |
| 737722300 | Medicaid | MN | |
| 1B004JE | Other | MN | BCBS OF MINNESOTA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 8671 (Minnesota) | Primary |
| 1223P0300X | Dentist - Periodontics | 11710 (Minnesota) | Secondary |
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