Provider Demographics
NPI:1952446031
Name:JIMENEZ, FERNANDO JORGE (DMD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:JORGE
Last Name:JIMENEZ
Suffix:
Gender:M
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:A9 CALLE ACROPOLIS
Mailing Address - Street 2:MONTE OLIMPO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4950
Mailing Address - Country:US
Mailing Address - Phone:787-720-1684
Mailing Address - Fax:787-708-5272
Practice Address - Street 1:OFICINA DENTAL LA CUMBRE LOCAL #3 CENTRO COMERCIAL LA
Practice Address - Street 2:CUMBRE URB LA CUMBRE
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-720-1684
Practice Address - Fax:787-708-5272
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice