Jennifer K Azevedo, RDA, OSA

Primary specialty

Dental AssistantTaxonomy code 126800000X

License

RDS77618 Issued in CA

Practice address

201 E Orangeburg Ave Ste a
Modesto, CA 95350-5355

Phone

(209) 527-5050

Fax

(209) 527-0659

NPI assigned

Oct 9, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Jennifer K Bergland Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Greater Modesto Dental Implant &Oral Surgery Center

  • Oral and Maxillofacial Surgery (Dentist)
  • Modesto, CA
  • NPI 1326468752
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507507200000",
    "number": "1801306493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E. ORANGEBURG AVE",
            "address_2": "SUITE A",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "95350",
            "telephone_number": "209-527-5050",
            "fax_number": "209-527-0659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E ORANGEBURG AVE STE A",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953505355",
            "telephone_number": "209-527-5050",
            "fax_number": "209-527-0659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AZEVEDO",
        "first_name": "JENNIFER",
        "middle_name": "K",
        "name_prefix": "Mrs.",
        "credential": "RDA, OSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-09",
        "last_updated": "2017-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "126800000X",
            "taxonomy_group": "",
            "desc": "Dental Assistant",
            "state": "CA",
            "license": "RDS77618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "BERGLAND",
            "middle_name": "K",
            "prefix": "MS.",
            "credential": "RDA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Erika Ayon, L.C.S.W.
• Muhammad Naveed Ayyubi, DDS
• Fereydoun Azadi, M.D.
• Denise Azevedo Reis
• Adriana Azevedo, HS DIPLOMA
• Jerome M Azevedo, RN
• Jessica Azevedo
• Shararah Aziz
• Joyce Noreen Celis Aznar-Lester, RN
• Lesly Stephanie Azonos

• Dental Assistant in Modesto, CA
• Providers in Modesto, CA by specialty
• Dental Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.