Provider Demographics
NPI:1104959337
Name:JIMENEZ, BEVERLY ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:ANN
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 KEMP LN
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2095
Mailing Address - Country:US
Mailing Address - Phone:410-643-9411
Mailing Address - Fax:
Practice Address - Street 1:621 RIDGELY AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1081
Practice Address - Country:US
Practice Address - Phone:410-224-2660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD 115421223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry