| Name: | Jacob Werba, DDS, Ltd. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 20 Jan 2004 (21 years ago) |
| Identification Number: | 000137371 |
| ZIP code: | 02903 |
| County: | Providence County |
| Principal Address: | 655 BROAD STREET, PROVIDENCE, RI, 02903, USA |
| Purpose: | TO ENGAGE IN THE PRACTICE OF GENERAL DENTISTRY |
| NAICS: | 621210 - Offices of Dentists |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871705418 | 2007-05-04 | 2020-08-22 | 655 BROAD ST, PROVIDENCE, RI, 029071444, US | 655 BROAD ST, PROVIDENCE, RI, 029071444, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 401-751-9050 |
| Fax | 4018610873 |
Authorized person
| Name | DR. JACOB DAVID WERBA |
| Role | OWNER |
| Phone | 4017519050 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | DEN01863 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | JW57856 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| J. RICHARD RATCLIFFE, ESQ. | Agent | 40 WESTMINSTER STREET SUITE 700, PROVIDENCE, RI, 02903, USA |
| Name | Role | Address |
|---|---|---|
| JACOB WERBA | TREASURER | 655 BROAD STREET PROVIDENCE, RI 02907 USA |
| Name | Role | Address |
|---|---|---|
| JACOB WERBA | SECRETARY | 655 BROAD STREET PROVIDENCE, RI 02907 USA |
| Name | Role | Address |
|---|---|---|
| JACOB WERBA | PRESIDENT | 655 BROAD STREET PROVIDENCE, RI 02907- USA |
| Name | Role | Address |
|---|---|---|
| JACOB WERBA | DIRECTOR | 655 BROAD STREET PROVIDENCE, RI 02907 USA |
| Number | Name | File Date |
|---|---|---|
| 202451686590 | Annual Report | 2024-04-19 |
| 202338846660 | Annual Report | 2023-06-28 |
| 202338067380 | Revocation Notice For Failure to File An Annual Report | 2023-06-19 |
| 202215448350 | Annual Report | 2022-04-22 |
| 202193955280 | Annual Report | 2021-03-16 |
| 202039510950 | Annual Report | 2020-05-08 |
| 202038763780 | Statement of Change of Registered/Resident Agent | 2020-04-27 |
| 201987575680 | Annual Report | 2019-02-26 |
| 201855578070 | Annual Report | 2018-01-03 |
| 201730947760 | Annual Report | 2017-01-27 |
Date of last update: 09 Oct 2024
Sources: Rhode Island Department of State
