Provider Demographics
NPI:1376635656
Name:JIMENEZ, ARTHUR STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:STEVEN
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9911 E. 21ST
Mailing Address - Street 2:APT. #701
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206
Mailing Address - Country:US
Mailing Address - Phone:316-681-2688
Mailing Address - Fax:316-681-0869
Practice Address - Street 1:5331 E. 21ST. N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208
Practice Address - Country:US
Practice Address - Phone:316-681-2688
Practice Address - Fax:316-681-0869
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS5357OtherDENTAL LICENSE NUMBER
KS8917OtherBCBS NUMBER