Healthcare Provider Details

I. General information

NPI: 1114778743
Provider Name (Legal Business Name): JEAN CARLOS FERMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1637 MINERAL SPRING AVE
NORTH PROVIDENCE RI
02904-4042
US

IV. Provider business mailing address

100 DORRANCE ST UNIT T-5
PROVIDENCE RI
02903-2877
US

V. Phone/Fax

Practice location:
  • Phone: 401-519-1940
  • Fax:
Mailing address:
  • Phone: 919-521-7698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: