Basic Information
| Provider Information | |||||||||
| NPI: | 1164879680 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CERNA | ||||||||
| FirstName: | JORGE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4380 N MAIN ST APT 606 | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027201713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7866033732 | ||||||||
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| Practice Location | |||||||||
| Address1: | 387 QUARRY ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027231026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606792000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2016 | ||||||||
| LastUpdateDate: | 10/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 12000 | CT | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 122300000X | DL14368 | MA | Y | Dental Providers | Dentist |
No ID Information.