Provider Demographics
NPI:1538519822
Name:JIMENEZ, ANTHONY TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:TODD
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 1:21 N 12TH ST
Mailing Address - Street 2:#300
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-5161
Mailing Address - Country:US
Mailing Address - Phone:913-342-2552
Mailing Address - Fax:
Practice Address - Street 1:21 N 12TH ST
Practice Address - Street 2:#300
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-5161
Practice Address - Country:US
Practice Address - Phone:913-342-2552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61215122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist