Provider Demographics
NPI:1679344766
Name:FERNANDO JIMENEZ SEDA DENTISTA LLC.
Entity type:Organization
Organization Name:FERNANDO JIMENEZ SEDA DENTISTA LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ SEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-403-7979
Mailing Address - Street 1:A-9 ACROPOLIS
Mailing Address - Street 2:MONTE OLIMPO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-403-7979
Mailing Address - Fax:
Practice Address - Street 1:SANTA ROSA MALL
Practice Address - Street 2:2DO NIVEL SUITE 3B
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-740-0110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty