Provider Demographics
NPI:1801380316
Name:VENEGAS, XIMENA D (DMD)
Entity Type:Individual
Prefix:
First Name:XIMENA
Middle Name:D
Last Name:VENEGAS
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 1:3 CIRCLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-1213
Mailing Address - Country:US
Mailing Address - Phone:862-276-9243
Mailing Address - Fax:
Practice Address - Street 1:391 LYNNWAY
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1707
Practice Address - Country:US
Practice Address - Phone:617-393-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1857998122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist