Provider Demographics
NPI:1386764298
Name:JIMENEZ COLON, EMILIO ANTONIO (DMD)
Entity type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:ANTONIO
Last Name:JIMENEZ COLON
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 1:300 CANAL ST UNIT 8303
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1471
Mailing Address - Country:US
Mailing Address - Phone:787-644-5207
Mailing Address - Fax:
Practice Address - Street 1:2 WATER ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6229
Practice Address - Country:US
Practice Address - Phone:978-372-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0593521223P0700X
MO20170305271223P0700X
PR18601223P0700X
MADN18585381223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty