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General NPI Number Information
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NPI Number | 1083234215
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Entity Type | Individual
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Provider Name | JESSICA RACHEL BERMAN
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Gender | Female
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Dates
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Enumeration Date | 04/17/2020
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 5700 POST RD UNIT 5
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City | EAST GREENWICH
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State | RI
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Zip | 02818-3455
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Country | US
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Telephone | 401-285-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 52 BRETTON RD
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1208
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DEN03723
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License Number State | RI
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