Provider Demographics
NPI:1225239163
Name:ZIMMERMAN, RICHARD D (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17800 CUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-5409
Mailing Address - Country:US
Mailing Address - Phone:317-773-5515
Mailing Address - Fax:317-308-6478
Practice Address - Street 1:17800 CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-5409
Practice Address - Country:US
Practice Address - Phone:317-773-5515
Practice Address - Fax:317-308-6478
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007081A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics