Provider Demographics
NPI:1487623641
Name:JIMENEZ PUIG, GABRIEL (DMD)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:
Last Name:JIMENEZ PUIG
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 1:407 CALLE DEL PARQUE
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00912-3730
Mailing Address - Country:US
Mailing Address - Phone:787-721-3627
Mailing Address - Fax:787-721-3650
Practice Address - Street 1:407 CALLE DEL PARQUE
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00912-3730
Practice Address - Country:US
Practice Address - Phone:787-721-3627
Practice Address - Fax:787-721-3650
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice