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General NPI Number Information
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NPI Number | 1871112326
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Entity Type | Individual
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Provider Name | CHRISTIAN JIMENEZ DMD
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Gender | Male
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Dates
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Enumeration Date | 04/15/2020
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Last Update Date | 07/02/2024
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Provider Practice Location Address
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Address Line | 516 MARY ESTHER CUT OFF NW STE 2
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-4025
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Country | US
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Telephone | 850-460-3221
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Fax |
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Provider Business Mailing Address
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Address Line | 127 COVEWOOD WAY APT 101
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-2671
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Country | US
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Telephone | 443-345-7705
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 13149
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 25505
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License Number State | FL
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