Healthcare Provider Details

I. General information

NPI: 1093632598
Provider Name (Legal Business Name): JMJ ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 SHALLOWFORD RD STE 230
MARIETTA GA
30062-5078
US

IV. Provider business mailing address

4343 SHALLOWFORD RD STE 230
MARIETTA GA
30062-5078
US

V. Phone/Fax

Practice location:
  • Phone: 770-709-5040
  • Fax:
Mailing address:
  • Phone: 770-709-5040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. JEANNETTE JIMENEZ
Title or Position: DOCTOR/OWNER
Credential: DMD
Phone: 646-771-6675