Provider Demographics
NPI:1326125972
Name:JIMENEZ, CHARITO (DDS)
Entity Type:Individual
Prefix:
First Name:CHARITO
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 S WHITE RD STE C
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-3820
Mailing Address - Country:US
Mailing Address - Phone:408-259-7995
Mailing Address - Fax:408-259-8124
Practice Address - Street 1:1060 S WHITE RD STE C
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-3820
Practice Address - Country:US
Practice Address - Phone:408-259-7995
Practice Address - Fax:408-259-8124
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA375641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA520291OtherDENTICAL PIN NUMBER