Provider Demographics
NPI:1871705418
Name:JACOB WERBA DDS LTD
Entity type:Organization
Organization Name:JACOB WERBA DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WERBA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:401-751-9050
Mailing Address - Street 1:655 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-1444
Mailing Address - Country:US
Mailing Address - Phone:401-751-9050
Mailing Address - Fax:401-861-0873
Practice Address - Street 1:655 BROAD ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-1444
Practice Address - Country:US
Practice Address - Phone:401-751-9050
Practice Address - Fax:401-861-0873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN018631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIJW57856Medicaid