Provider Demographics
NPI:1083757868
Name:ZIMMERMAN, JEFFREY LEN (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LEN
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 E THUNDERBIRD ROAD
Mailing Address - Street 2:SUITE #A
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-5398
Mailing Address - Country:US
Mailing Address - Phone:602-993-9600
Mailing Address - Fax:602-942-0739
Practice Address - Street 1:770 E THUNDERBIRD ROAD
Practice Address - Street 2:SUITE #A
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-5398
Practice Address - Country:US
Practice Address - Phone:602-993-9600
Practice Address - Fax:602-942-0739
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3415122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist