Provider Demographics
NPI:1184120875
Name:ACEVEDO JIMENEZ, MARICE (DDS)
Entity type:Individual
Prefix:
First Name:MARICE
Middle Name:
Last Name:ACEVEDO JIMENEZ
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 1:11904 MIRAMAR PKWY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7005
Mailing Address - Country:US
Mailing Address - Phone:954-639-7560
Mailing Address - Fax:954-639-7563
Practice Address - Street 1:11904 MIRAMAR PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-7005
Practice Address - Country:US
Practice Address - Phone:954-639-7560
Practice Address - Fax:954-639-7563
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL252201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program