Provider Demographics
NPI:1871112326
Name:JIMENEZ, CHRISTIAN (DMD)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 COVEWOOD WAY APT 101
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-2671
Mailing Address - Country:US
Mailing Address - Phone:443-345-7705
Mailing Address - Fax:
Practice Address - Street 1:516 MARY ESTHER CUT OFF NW STE 2
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4025
Practice Address - Country:US
Practice Address - Phone:850-460-3221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT131491223S0112X
FL255051223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery