Provider Demographics
NPI:1811506082
Name:JORGE JIMENEZ-MARQUEZ, DMD, PLLC
Entity type:Organization
Organization Name:JORGE JIMENEZ-MARQUEZ, DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ-MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-203-2961
Mailing Address - Street 1:110 E BRUNER AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-5700
Mailing Address - Country:US
Mailing Address - Phone:702-816-5885
Mailing Address - Fax:
Practice Address - Street 1:110 E BRUNER AVE STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-5700
Practice Address - Country:US
Practice Address - Phone:702-816-5885
Practice Address - Fax:702-816-5886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty