Provider Demographics
NPI:1619441219
Name:JERGER, BAILEE JO (MDT, RDH)
Entity Type:Individual
Prefix:
First Name:BAILEE
Middle Name:JO
Last Name:JERGER
Suffix:
Gender:F
Credentials:MDT, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1005
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56619-1005
Mailing Address - Country:US
Mailing Address - Phone:507-529-0436
Mailing Address - Fax:218-444-6057
Practice Address - Street 1:3622 MOBERG DR NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-5644
Practice Address - Country:US
Practice Address - Phone:507-529-0436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH10578124Q00000X
MNDT116125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist
No124Q00000XDental ProvidersDental Hygienist