Provider Demographics
NPI:1043486970
Name:JOHN F. JIMENEZ, D.D.S., P.C
Entity Type:Organization
Organization Name:JOHN F. JIMENEZ, D.D.S., P.C
Other - Org Name:FRONTIER PLACE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-369-4477
Mailing Address - Street 1:3360 LACROSSE LN
Mailing Address - Street 2:SUITE #100
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8136
Mailing Address - Country:US
Mailing Address - Phone:630-369-4477
Mailing Address - Fax:630-369-4422
Practice Address - Street 1:3360 LACROSSE LN
Practice Address - Street 2:SUITE #100
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8136
Practice Address - Country:US
Practice Address - Phone:630-369-4477
Practice Address - Fax:630-369-4422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190260221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty