Provider Demographics
NPI:1659414027
Name:JIMENEZ-DURU, MARIA R (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:R
Last Name:JIMENEZ-DURU
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 1:2300 STATE ROUTE 33
Mailing Address - Street 2:OLIVER BROTHERS BUILDING
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4362
Mailing Address - Country:US
Mailing Address - Phone:732-774-0077
Mailing Address - Fax:732-988-1176
Practice Address - Street 1:2300 STATE ROUTE 33
Practice Address - Street 2:OLIVER BROTHERS BUILDING
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4362
Practice Address - Country:US
Practice Address - Phone:732-774-0077
Practice Address - Fax:732-988-1176
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021933001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0101052Medicaid