Individual
DR. ROSITA C. JIMENEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PERIODONTIST
Contact information
Practice address
2621 S LAWNDALE AVE, SUITE B, CHICAGO, IL 60623-4520
(773) 762-0200
(773) 762-0201
Mailing address
3213 FOXRIDGE CT, WOODRIDGE, IL 60517-3281
(630) 910-7213
(773) 762-0201
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
019.015877
IL
1223P0300X
Periodontics
Primary
021.001004
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DWP11770
DENTAL WELLNESS PARTNERS
IL
Enumeration date
11/10/2006
Last updated
03/01/2013
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