Provider Demographics
NPI:1114939071
Name:ZIMMERMAN, ROD S (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROD
Middle Name:S
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 1:3676 CROWN POINT CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5966
Mailing Address - Country:US
Mailing Address - Phone:904-268-2011
Mailing Address - Fax:904-880-3100
Practice Address - Street 1:3676 CROWN POINT CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5966
Practice Address - Country:US
Practice Address - Phone:904-268-2011
Practice Address - Fax:904-880-3100
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00104211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice