Provider Demographics
NPI:1306861760
Name:ZIMMER, GREGORY GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:GEORGE
Last Name:ZIMMER
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 1:6716 EASTSIDE DR NE
Mailing Address - Street 2:STE 4
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-1174
Mailing Address - Country:US
Mailing Address - Phone:253-927-8040
Mailing Address - Fax:253-927-3846
Practice Address - Street 1:6716 EASTSIDE DR NE
Practice Address - Street 2:STE 4
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-1174
Practice Address - Country:US
Practice Address - Phone:253-927-8040
Practice Address - Fax:253-927-3846
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA53431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice