Provider Demographics
NPI:1033265681
Name:JIMENEZ, SALDANA, RODRIGUEZ, DENTISTAS CSP
Entity Type:Organization
Organization Name:JIMENEZ, SALDANA, RODRIGUEZ, DENTISTAS CSP
Other - Org Name:CENTRO DENTAL FAMILIAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:JORGE
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-743-7777
Mailing Address - Street 1:53 AVE ESMERALDA, BOX 51
Mailing Address - Street 2:URB. MUNOZ RIVERA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4429
Mailing Address - Country:US
Mailing Address - Phone:787-743-7777
Mailing Address - Fax:787-745-3405
Practice Address - Street 1:30 CALLE TERMINAL
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2627
Practice Address - Country:US
Practice Address - Phone:787-743-7777
Practice Address - Fax:787-745-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty