Provider Demographics
NPI:1457419129
Name:JIMENEZ, JOHN FREDERICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREDERICK
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 LACROSSE LN
Mailing Address - Street 2:SUITE #100
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8136
Mailing Address - Country:US
Mailing Address - Phone:630-369-4477
Mailing Address - Fax:630-369-4422
Practice Address - Street 1:3360 LACROSSE LN
Practice Address - Street 2:SUITE #100
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8136
Practice Address - Country:US
Practice Address - Phone:630-369-4477
Practice Address - Fax:630-369-4422
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice