Provider Demographics
NPI:1205059987
Name:GIMENEZ, PETER JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOSEPH
Last Name:GIMENEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13110 BIRCH DR
Mailing Address - Street 2:SUITE 172
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-4160
Mailing Address - Country:US
Mailing Address - Phone:402-493-3636
Mailing Address - Fax:402-493-3649
Practice Address - Street 1:13110 BIRCH DR
Practice Address - Street 2:SUITE 172
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-4160
Practice Address - Country:US
Practice Address - Phone:402-493-3636
Practice Address - Fax:402-493-3649
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE57041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice