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General NPI Number Information
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NPI Number | 1871705418
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Entity Type | Organization
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Legal Business Name | JACOB WERBA DDS LTD
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 655 BROAD ST
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City | PROVIDENCE
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State | RI
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Zip | 02907-1444
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Country | US
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Telephone | 401-751-9050
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Fax | 401-861-0873
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Provider Business Mailing Address
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Address Line | 655 BROAD ST
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City | PROVIDENCE
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State | RI
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Zip | 02907-1444
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Country | US
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Telephone | 401-751-9050
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Fax | 401-861-0873
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACOB DAVID WERBA
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Credential | DDS
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Telephone | 401-751-9050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN01863
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License Number State | RI
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