Provider Demographics
NPI:1023823705
Name:L.N. ORAL AND MAXILLOFACIAL SURGERY PLLC
Entity type:Organization
Organization Name:L.N. ORAL AND MAXILLOFACIAL SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-834-8473
Mailing Address - Street 1:11925 CLIMBING FERN AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-4092
Mailing Address - Country:US
Mailing Address - Phone:813-834-8473
Mailing Address - Fax:
Practice Address - Street 1:11278 SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-2140
Practice Address - Country:US
Practice Address - Phone:813-834-8473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial RadiologyGroup - Single Specialty