Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | 16795 | MD |
Y | 1223P0300X | Periodontist | 22DI02877900 | NJ |
N | 1223P0300X | Periodontist | DEN1002200 | DC |
N | 1223P0300X | Periodontist | DS041521 | PA |
NPI | 1124410741 |
---|---|
Provider Name | Andres Jimenez Wolf |
First Address | Baltimore, MD 21230-5510 |
Second Address | Manalapan, NJ 07726-3016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2015 |
Last Update Date | 11/01/2022 |