Healthcare Provider Details

I. General information

NPI: 1205581014
Provider Name (Legal Business Name): KENYA JIMENEZ IORIO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 07/26/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

8085NW 42 STREET
DORAL FL
33166
US

V. Phone/Fax

Practice location:
  • Phone: 305-689-6725
  • Fax: 305-689-1133
Mailing address:
  • Phone: 786-296-5733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number29402
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: