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SOUTHERN MINNESOTA PERIODONTICS, PA
NPI 1609012624
Dentist - Periodontics in Mankato, MN

Active since December 22, 2008
99 NAVAHO AVE, SUITE 102, MANKATO, MN 56001(507) 345-7537(507) 345-7538 Get Directions Write a Review

NPPES record last updated: December 22, 2008. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Southern Minnesota Periodontics, Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHERN MINNESOTA PERIODONTICS, PA (NPI 1609012624) is a healthcare organization registered as a periodontics in Mankato, Minnesota and active in the NPI registry since December 2008. The organization lists Gary Jernberg, Owner, as its authorized official.

NPPES Registry Identity

NPI1609012624
Entity TypeOrganization
Primary Taxonomy1223P0300X
Legal Business NameSOUTHERN MINNESOTA PERIODONTICS, PA
Location Address99 NAVAHO AVE, SUITE 102Mankato, MN 56001-4876
Mailing Address99 Navaho Ave, Suite 102Mankato, MN 56001-4876 · (507) 345-7537 · Fax (507) 345-7538
Phone(507) 345-7537
Fax(507) 345-7538
Organization SubpartNo
Authorized OfficialGary JernbergOwner · (507) 345-7537
Enumeration DateDecember 22, 2008
✔ NPI 1609012624 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · PeriodonticsDental Providers
Taxonomy Code1223P0300X
Licenses✔ Licensed in MN · 8671✔ Licensed in MN · 11710
Definition

That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.

99 NAVAHO AVE, Mankato, MN 56001
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Other Identifiers 3

Other000839878PA · United Concordia
Other1B004JEMN · Bcbs Of Minnesota
Medicaid737722300MN

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. GARY ROBERT JERNBERG D.D.S., M.S.D.
Dentist (Periodontics)
99 NAVAHO AVE, SUITE 102
MANKATO, MN 56001
Blue Earth County (507) 345-7537
SOUTHERN MINNESOTA PERIODONTICS PA
Dentist (Periodontics)
99 NAVAHO AVE, SUITE #102
MANKATO, MN 56001
Blue Earth County (507) 345-7537
GARY R. JERNBERG, D.D.S., M.S.D.
Dentist (Periodontics)
99 NAVAHO AVE, SUITE 102
MANKATO, MN 56001
Blue Earth County (507) 345-7537

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southern Minnesota Periodontics, PA's NPI number?

The NPI number for Southern Minnesota Periodontics, PA is 1609012624. It was assigned to this organization in the NPPES registry on December 22, 2008.

Where is Southern Minnesota Periodontics, PA located?

Southern Minnesota Periodontics, PA is located at 99 Navaho Ave Suite 102, Mankato, MN 56001. The listed phone number is (507) 345-7537.

What is Southern Minnesota Periodontics, PA's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

When was this NPI record last updated?

The NPPES record for Southern Minnesota Periodontics, PA was last updated on December 22, 2008. NPI Profile syncs with the weekly NPPES data releases published by CMS.