Individual
RICHARD JIMENEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1515 E COLUMBIA ST, OTHELLO, WA 99344-1846
(509) 488-5256
(509) 488-9939
Mailing address
1515 E COLUMBIA ST, OTHELLO, WA 99344-1846
(509) 488-5256
(509) 488-9939
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE61161850
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2178856
—
WA
Enumeration date
06/11/2020
Last updated
07/14/2021
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