Provider Demographics
NPI:1831252097
Name:JIMENEZ, EDWARD YLAGAN (DDS)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:YLAGAN
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 1:7055 ENGLE RD
Mailing Address - Street 2:STE 501
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-8491
Mailing Address - Country:US
Mailing Address - Phone:440-243-1600
Mailing Address - Fax:440-243-1604
Practice Address - Street 1:7055 ENGLE RD
Practice Address - Street 2:STE 501
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-8491
Practice Address - Country:US
Practice Address - Phone:440-243-1600
Practice Address - Fax:440-243-1604
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH195501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2199848Medicaid