MEDICARE: DR. JESSICA LARRAONA BERNARDES DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30.027155	OH

General Provider Information

NPI Number	:	1639853575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA LARRAONA BERNARDES DDS

Provider Business Mailing Address
First Line	:	3455 BANNING RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-5210
Country	:	US
Telephone Number	:	202-374-5879
Fax Number	:

Provider Business Practice Location Address
First Line	:	880 EASTGATE NORTH DR STE 101
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45245-2051
Country	:	US
Telephone Number	:	513-978-5859
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2023
Last Update Date	:	06/12/2023

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