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General NPI Number Information
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NPI Number | 1023823705
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Entity Type | Organization
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Legal Business Name | L.N. ORAL AND MAXILLOFACIAL SURGERY PLLC
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 11278 SULLIVAN ST
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City | RIVERVIEW
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State | FL
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Zip | 33578-2140
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Country | US
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Telephone | 813-834-8473
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Fax |
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Provider Business Mailing Address
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Address Line | 11925 CLIMBING FERN AVE
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City | RIVERVIEW
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State | FL
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Zip | 33579-4092
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Country | US
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Telephone | 813-834-8473
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FERNANDO J JIMENEZ
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Credential | DMD
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Telephone | 813-834-8473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0008X
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Taxonomy Name | Oral and Maxillofacial Radiology Dentistry
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License Number |
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License Number State |
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