Provider Demographics
NPI:1538303250
Name:BLIESATH, ENIL JIMENEZ (DDS)
Entity type:Individual
Prefix:MRS
First Name:ENIL
Middle Name:JIMENEZ
Last Name:BLIESATH
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 1:925 E PENNSYLVANIA AVE STE G
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3432
Mailing Address - Country:US
Mailing Address - Phone:760-747-7912
Mailing Address - Fax:760-747-6453
Practice Address - Street 1:925 E PENNSYLVANIA AVE STE G
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3432
Practice Address - Country:US
Practice Address - Phone:760-747-7912
Practice Address - Fax:760-747-6453
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA559191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice