| NPI | 1609012624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY JERNBERG Owner 507-345-7537 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MN 8671) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MN 11710) |
| Enumeration Date | 2008-12-22 |
| Last Update Date | 2008-12-22 |