Provider Demographics
NPI:1356861405
Name:CHECA, XIMENA (DMD)
Entity Type:Individual
Prefix:
First Name:XIMENA
Middle Name:
Last Name:CHECA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E SUGARLAND HWY
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-3122
Mailing Address - Country:US
Mailing Address - Phone:863-983-4847
Mailing Address - Fax:
Practice Address - Street 1:212 E SUGARLAND HWY
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3122
Practice Address - Country:US
Practice Address - Phone:863-983-4847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22545122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist