Provider Demographics
NPI:1033452370
Name:JIMENEZ, MANUEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 S LEJEUNE ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146
Mailing Address - Country:US
Mailing Address - Phone:305-667-5539
Mailing Address - Fax:305-667-5593
Practice Address - Street 1:4950 S LE JEUNE RD
Practice Address - Street 2:SUITE B
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2231
Practice Address - Country:US
Practice Address - Phone:305-667-5539
Practice Address - Fax:305-667-5593
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18326122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist