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General NPI Number Information
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NPI Number | 1396434379
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Entity Type | Organization
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Legal Business Name | CHILDREN'S & PEDIATRIC DENTISTRY OF WELLINGTON, INC.
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Dates
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Enumeration Date | 05/04/2023
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Last Update Date | 05/04/2023
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Provider Practice Location Address
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Address Line | 12798 FOREST HILL BLVD STE 305
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City | WELLINGTON
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State | FL
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Zip | 33414-4704
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Country | US
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Telephone | 561-793-7515
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Fax |
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Provider Business Mailing Address
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Address Line | 12798 FOREST HILL BLVD STE 305
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City | WELLINGTON
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State | FL
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Zip | 33414-4704
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. FRANCISCO JIMENEZ
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Credential |
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Telephone | 561-793-7515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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