Provider Demographics
NPI:1366564825
Name:JIMENEZ, SYLVIA G (DDS)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:G
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11398 SE 82ND AVE
Mailing Address - Street 2:STE 802
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97086-7637
Mailing Address - Country:US
Mailing Address - Phone:503-513-6000
Mailing Address - Fax:
Practice Address - Street 1:11398 SE 82ND AVE
Practice Address - Street 2:STE 802
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97086-7637
Practice Address - Country:US
Practice Address - Phone:503-513-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD99791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6393OtherDDS LICENSE #
AZ6393OtherDDS LICENSE #