Provider Demographics
NPI:1730325713
Name:JIMENEZ, ELIECER (DDS)
Entity type:Individual
Prefix:
First Name:ELIECER
Middle Name:
Last Name:JIMENEZ
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 1:7 Y HERRERA NO. 1609 'A'
Mailing Address - Street 2:
Mailing Address - City:H. MATAMOROS
Mailing Address - State:TAMPULIPAS
Mailing Address - Zip Code:87300
Mailing Address - Country:MX
Mailing Address - Phone:52868-813-9930
Mailing Address - Fax:52868-816-9405
Practice Address - Street 1:7 Y HERRERA 160 'A'
Practice Address - Street 2:
Practice Address - City:H. MATAMOROS
Practice Address - State:TAMAULIPAS
Practice Address - Zip Code:87300
Practice Address - Country:MX
Practice Address - Phone:868-813-9930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ382574245122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist