Provider Demographics
NPI:1639853575
Name:BERNARDES, JESSICA LARRAONA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LARRAONA
Last Name:BERNARDES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 BANNING RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-5210
Mailing Address - Country:US
Mailing Address - Phone:202-374-5879
Mailing Address - Fax:
Practice Address - Street 1:880 EASTGATE NORTH DR STE 101
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-2051
Practice Address - Country:US
Practice Address - Phone:513-978-5859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.027155122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist