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NPI Code Detail

MEDICARE: BALTASAR JIMENEZ D.M.D.

MEDICARE: BALTASAR JIMENEZ D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDN10922FL

General Provider Information

NPI Number : 1104031442
Entity Type Code : Individual
Provider Name (Legal Business Name) : BALTASAR JIMENEZ D.M.D.
Provider Business Mailing Address
First Line : 5917 BENEVA RD
Second Line :
City : SARASOTA
State : FL
Zip : 34238-2504
Country : US
Telephone Number : 941-924-2939
Fax Number : 941-924-2026
Provider Business Practice Location Address
First Line : 5917 BENEVA RD
Second Line :
City : SARASOTA
State : FL
Zip : 34238-2504
Country : US
Telephone Number : 941-924-2939
Fax Number : 941-924-2026
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2007
Last Update Date : 07/08/2007

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