Provider Demographics
NPI:1952313918
Name:BERIN, JENNA FIMAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:FIMAN
Last Name:BERIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 NORTHERN BLVD
Mailing Address - Street 2:LOUDON PLAZA
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12204-1029
Mailing Address - Country:US
Mailing Address - Phone:518-462-1471
Mailing Address - Fax:518-462-1471
Practice Address - Street 1:326 NORTHERN BLVD
Practice Address - Street 2:LOUDON PLAZA
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204-1029
Practice Address - Country:US
Practice Address - Phone:518-462-1471
Practice Address - Fax:518-462-1471
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0489151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
BF6906195OtherDEA