Provider Demographics
NPI:1336250521
Name:JIMENEZ, DAVID RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RAY
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 92994
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-2994
Mailing Address - Country:US
Mailing Address - Phone:505-259-6591
Mailing Address - Fax:505-299-7718
Practice Address - Street 1:7968 SARTAN WAY NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3128
Practice Address - Country:US
Practice Address - Phone:505-823-4566
Practice Address - Fax:505-299-7718
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM14101223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics