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General NPI Number Information
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NPI Number | 1881528792
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Entity Type | Individual
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Provider Name | MICHAEL ANGELO JIMENEZ MARTINEZ DDS
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Gender | Male
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Dates
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Enumeration Date | 06/09/2026
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Last Update Date | 06/09/2026
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Provider Practice Location Address
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Address Line | 301 S LIVINGSTON AVE STE 102
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City | LIVINGSTON
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State | NJ
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Zip | 07039-3929
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Country | US
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Telephone | 973-221-2131
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Fax |
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Provider Business Mailing Address
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Address Line | 132 BLAINE ST APT 1
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City | PASSAIC
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State | NJ
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Zip | 07055-1906
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Country | US
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Telephone | 973-836-2713
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI03156300
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License Number State | NJ
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