Provider Demographics
NPI:1407196355
Name:JIMENEZ SOTO, CAROLINA (DMD)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:JIMENEZ SOTO
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 1:42032 SECT PIQUINAS
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-9492
Mailing Address - Country:US
Mailing Address - Phone:787-396-2542
Mailing Address - Fax:
Practice Address - Street 1:42032 SECT PIQUINAS
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-9492
Practice Address - Country:US
Practice Address - Phone:787-396-2542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057430-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist